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So Help Me God: Substance Abuse, Religion and Spirituality. 

A CASA White Paper. 

Columbia Univ. , New York, NY. National Center on Addiction 
and Substance Abuse. 

John Templeton Foundation, Radnor, PA. 

2001 - 11-00 

59p.; Also sponsored by The Bodman Foundation. 

National Center on Addiction and Substance Abuse at Columbia 
University, 633 Third Ave., 19th Floor, New York, NY 
10017-6706 ($10). Tel: 212-841-5255; Fax: 212-956-8020; Web 
site: http://www.casacolumbia.org. For full text: 
http : //www. casacolumbia. org/usr__doc/ spirituality.pdf . 

Reports - Research (143) 

MF01/PC03 Plus Postage. 

Attitude Measures; *Beliefs; *Clergy; Counseling; Counselor 
Training; Drug Rehabilitation; Illegal Drug Use; 
Intervention; Psychologists; *Religion; *Religious Factors; 
Spirituality; *Substance Abuse; Theological Education 



ABSTRACT 



There is a powerful religious commitment among people in 
America; nearly 92% of the population is affiliated with a specific religion. 
This report presents findings from a 2 -year study of the attitudes and 
experiences of clergy regarding substance abuse and the training they 
received in schools of theology or in seminaries . Too often clergy and 
physicians do not overlap their care, something that could help recovery and 
ease the pain of substance abuse clients. Prior research from the National 
Center on Addiction and Substance Abuse has identified a helpful connection 
between spiritual and religious practices and a lower risk for substance 
abuse or addiction. A main finding of this study suggests that a better 
understanding by clergy of the disease of addiction and a better appreciation 
by helping professionals, especially psychiatrists and psychologists, about 
the power of God, religion, and spirituality holds enormous potential for the 
prevention and treatment of substance abuse. (Contains 1 table, 10 figures, 
and 124 references.) (JDM) 



Reproductions supplied by EDRS are the best that can be made 
from the original document. 



'^31488 



The National Center on 
Addiction and Substance Abuse 
at Columbia University 







CN 

m 

m 

o 

VO 



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W 



633 Third Avenue 
New York, NY 10017-6706 

phone 212 841 5200 
fax 212 956 8020 
www.casacolumbia.org 

Board of Directors 

Joseph A. Califano, Jr. 
Chairman and President 

Columba Bush 
Kennelh 1. Chenaull 
Jamie Lee Curlis 
James Dimon 
Mary Fisher 
Douglas A. Fraser 
Leo-Arlhur Kelmenson 
Donald K. Keough 
David A. Kessler, M.D. 
Manuel T. Pacheco, Ph.D. 
Joseph J. Plunieri 11 
E. John Rosenwald, Jr. 
George Rupp, Ph.D. 
Michael P. Schulhof 
Louis W. Sullivan, M.D. 
Michael A. Wiener 



Directors limeritus 

James E. Burke (1992-1997) 
Belly Ford (1992-1998) 
Barbara C. Jordan (1992-1996) 
LaSalle Leffall (1992-2001) 
Nancy Reagan (1995-2000) 
Linda J. Rice (1992-1996) 
Michael I. Sovern (1992-1993) 

- Frank G. Wells (1992-1994) 



So Help Me God: 

Substance Abuse, Religion and Spirituality 



A CASA White Paper 



November 2001 



Funded by: 






The Bodman Foundation 
John Templeton Foundation 




U.S. DEPARTMENT OF EDUCATION 
Office of Educational Research and Improvement 

EDUCATIONAL RESOURCES INFORMATION 
CENTER (ERIC) 

□ This document has been reproduced as 
received from the person or organization 
originating it. 

□ Minor changes have been made to 
improve reproduction quality. 



• Points of view or opinions stated in this 
document do not necessarily represent 
official OERI position or policy. 



PERMISSION TO REPRODUCE AND BESX COPY AVAILABLE 

DISSEMINATE THIS MATERIAL HAS 
BEEN GRANTED BY 

— 2 

TO THE EDUCATIONAL RESOURCES 
INFORMATION CENTER (ERIC) 



Board of Directors 



Columba Bush 
First Lady of Florida 

Joseph A. Califano, Jr. 

Chairman and President of CASA 

Kenneth I. Chenault 

Chairman and Chief Executive Officer, American Express Company 
Jamie Lee Curtis 
James Dimon 

Chairman and CEO, Bank One Corporation 

Mary Fisher 
Mary Fisher Care Fund 

Douglas A. Fraser 

Professor of Labor Studies at Wayne State University 
(former President of United Auto Workers) 

Leo-Arthur Kelmenson 

Chairman of the Board of FCB Worldwide 

Donald R. Keough 

Chairman of the Board of Allen and Company Incorporated 
(former President of The Coca-Cola Company) 

David A. Kessler, M.D. 

Dean of Yale University School of Medicine 

Manuel T. Pacheco, Ph.D. 

President of The University of Missouri 

Joseph J. Plumeri II 

Chairman and CEO of The Willis Group Limited 
£. John Rosenwald, Jr. 

Vice Chairman of The Bear Steams Companies Inc. 

George Rupp, Ph.D. 

President of Columbia University 

Michael P. Schulhof 

Louis W. Sullivan, M.D. 

President of Morehouse School of Medicine 

Michael A. Wiener 

Founder and Chairman Emeritus, Infinity Broadcasting Corporation 

Directors Emeritus 
James E. Burke (1992-1997) 

Betty Ford (1992-1998) 

Barbara C. Jordan (1992-1996) 

LaSalle D. Leffall, Jr., M.D., F.A.C.S. (1992-2001) 

Nancy Reagan (1995-2000) 

Linda Johnson Rice (1992-1996) 

Michael I. Sovern (1992-1993) 

Frank G. Wells (1992-1994) 

Copyright © 2001. All rights reserved. May not be used or reproduced without the express written permission of The 
National Center on Addiction and Substance Abuse at Columbia University. 

er|c 3 



Table of Contents 



Accompanying Statement i 

I. Introduction and Executive Summary 1 

Key Findings 2 

Next Steps 3 

II. What’s the Connection? 5 

Religion and Spirituality: Defining Our Terms 5 

A Nation of Believers 6 

Adult Church Goers Use Substances Less ; 7 

Alcohol 7 

Tobacco 7 

Illicit Drugs 7 

When Religion is Important, Adult Substance Use is Lower 8 

Alcohol 8 

Tobacco 8 

Illicit Drugs 8 

The Protective Influence of Religion for Youth 8 

Teen Religious Attendance and Beliefs Equal Lower Use 9 

Alcohol 9 

Tobacco 10 

Illicit Drugs 10 

Religious Teens Learn More About Drug Risk from Parents 10 

Religious Engagement Lowers Risk for College Drinking 10 

Religion, Spirituality and Health 11 

III. How Do Religion and Spirituality Influence Substance Use? 13 

Proscriptions from Religious Groups 13 

Religious Sanctions Reduce Substance Use 15 

The Paradoxical User 1 5 

The Supportive Role of the Religious/Spiritual Community 16 

Family 16 

Peers 16 

Adult Social Networks 16 

Direct Connection to a Power Greater Than Self 17 

IV. The Role of the Clergy 19 

Many Substance Abusers Turn to Clergy for Help 19 

Clergy: Substance Abuse an Important Problem 20 

Few Clergy Members Trained to Address Substance Abuse 21 

The Discoimect Between Preaching and the Problem 22 

V. Prevention, Intervention, Treatment and Recovery 23 

Prevention 23 

CASASTART 24 

School-Based Prevention Programs 24 

Clergy 24 

Alcoholics Anonymous and Narcotics Anonymous 24 

Intervention 26 

Teen Challenge 26 



ERIC 



4 



Other Formal Interventions 26 

Informal Interventions 26 

Treatment and Recovery 26 

Religion 27 

Spirituality 27 

Combining Treatment and Spirituality 28 

Therapeutic Communities 28 

Prison-Based Programs 28 

Hazelden 28 

The Betty Ford Center (BFC) 28 

Barriers to Linking Treatment and Spirituality 29 

VI. Making the Spiritual Connection 31 

For the Clergy 31 

For Physicians and Treatment Providers 32 

Expand Our Current Knowledge Base 32 

Notes 33 

Appendix A-National Data Sets 40 

Appendix B-CASA’s Surveys of Clergy and Schools of Theology 43 

Reference List 44 



O 

ERIC 



5 




Accompanying Statement by 

Joseph A. Califano, Jr., Chairman and President 

America has a unique and powerful tradition of 
religious commitment: 95 percent of our people 
believe in God and 92 percent are affiliated with 
a specific religion. Our nation is richly endowed 
with an astonishing array of churches and 
cathedrals, synagogues, Islamic centers and 
mosques, Hindu and Buddhist temples. 

America is the most medically advanced nation 
in the world. Cities across our country house the 
most sophisticated hospital and health care 
complexes and equipment. Our physician 
training has given us the finest medical 
professionals and our pharmaceutical companies 
have no peer. 

Too often clergy and physicians, religion and 
science, are ships passing in the night. When we 
separate the worlds of medicine and spirituality, 
we deny a host of individuals help that may aid 
their recovery and ease their pain. This is 
especially true with respect to substance abuse 
and addiction. 

The key finding of this two-year study is this: if 
ever the sum were greater than the parts it is in 
combining the power of God, religion and 
spirituality with the power of science and 
professional medicine to prevent and treat 
substance abuse and addiction. A better 
understanding by the clergy of the disease of 
alcohol and drug abuse and addiction among 
members of their congregations and a better 
appreciation by the medical profession, 
especially psychiatrists and psychologists, of the 
power of God, religion and spirituality to help 
patients with this disease hold enormous 
potential for prevention and treatment of 
substance abuse and addiction that can help 
millions of Americans and their families. 

For many individuals working to shake the 
shackles of addiction and maintain sobriety, 
sound advice might well be: work at it as 




6 



though everything depended on you and pray as 
though everything depended on God. 

The importance of God in American life can be 
seen far beyond our churches, synagogues and 
mosques. “In God We Trust” is emblazoned on 
our currency. Moments of prayer and silent 
meditation are observed in schools and public 
meetings. Our leaders and our citizens invoke 
the help of God; in moments of tragedy and 
crisis, individuals and clergy transcend the 
boundaries of their faith to pray together for 
comfort and resolve. 

People with strong religious or spiritual beliefs 
are healthier, heal faster and live longer than 
those without them. Studies have begun to 
document the role of prayer in healing. This 
unprecedented report concludes that religion and 
spirituality can play a powerful role in the 
prevention and treatment of substance abuse and 
in the maintenance of sobriety. 

On the prevention front, for both teenagers and 
adults, attendance at church services once a 
week or more is associated with significantly 
reduced risks of drinking, binge drinking, 
smoking and using marijuana or other illicit 
drugs. Compared to teens who attend religious 
services weekly or more, teens who never attend 
religious services are twice as likely to drink, 
more than twice as likely to smoke, more than 
three times likelier to use marijuana or binge 
drink and almost four times likelier to use illicit 
drugs. Adults who never attend religious 
services are almost twice as likely to drink, three 
times likelier to smoke, five times likelier to use 
illicit drugs other than marijuana, seven times 
likelier to binge drink and almost eight times 
likelier to use marijuana than adults who attend 
^religious services weekly or„more. College^ _ 
students with no religious affiliation are more 
likely to drink and binge drink than those who 
identify themselves as Catholics or Protestants. 

The beneficial effects of a religious or spiritual 
connection are not limited to those who attend 
church frequently. Adults and teens to whom 
religion is important are far less likely to use 
addictive substances. Religion and spirituality 
can be important, sometimes determinative 



companions to the treatment and recovery 
process. Many recovering alcoholics and 
addicts attribute their recovery to their religious 
or spiritual beliefs and the support of a 
community of believers. Treatment programs 
that incorporate 12-Step, spiritually-based 
components (Alcoholics Anon)mious or 
Narcotics Anonymous) can show better 
treatment outcomes than those lacking a spiritual 
base. 

In view of the significance of religion to 
prevention and treatment of substance abuse, the 
, most troubling findings of this report are the 
discoveries of two profound disconnects: one, 
the extent to which clergy see substance abuse 
as a problem among the congregations and 
families they serve members and lack the 
knowledge and training of how to deal with the 
problem; the other, between the importance of 
God, religion and spirituality to effective 
treatment and maintenance of sobriety and the 
failure of the medical profession to tap this in 
ministering to substance abusers and addicts. 

As part of our research, CASA conducted an 
unprecedented survey of attitudes and 
experiences of clergy regarding substance abuse 
and the training in this field that schools of 
theology and seminaries provide. Of the clergy 
that CASA surveyed, 94.4 percent consider 
substance abuse and addiction to be important 
issues that they confront. Yet, at best only 12.5 
percent of priests, ministers and rabbis 
completed coursework related to substance 
abuse during their theological studies and only 
36.5 percent preach a sermon addressing the 
issue more than once a year. This is particularly 
disturbing since alcohol and drug abuse and 
addiction are so implicated in child and spousal 
_ abusey violent crime, rape, teen prggnancy and 
sexually transmitted diseases, family breakup 
and divorce, school dropout and failure, 
debilitating accidents and job loss-all problems 
that clergy confront every day among their 
congregations. 

Equally troubling is the lack of recognition 
among health care providers— especially 
psychiatrists, psychologists and other mental 
health professionals— of the importance to 



patients of God, religion and spirituality to their 
treatment. Seventy-nine percent of Americans 
believe that spiritual faith can help people 
recover from disease and 63 percent think that 
physicians should talk to patients about spiritual 
faith. Ninety-nine percent of physicians in one 
study were convinced that religious beliefs can 
heal and 75 percent believe that prayer of others 
can promote a patient’s recovery. However, 
only 40 to 45 percent of mental health 
practitioners report a belief in God and only 37 
percent of psychiatrists responded affirmatively 
to the question: “If it were scientifically 
demonstrated that the use of a spiritual 
intervention (e.g. prayer) improved patient 
progress, would you perform that intervention?” 
Medical students have been found to be less 
religious and spiritual than their patients and less 
inclined to believe that God, religion and 
spirituality are important factors in patient care. 

The findings from this report call for action on 
three fronts: 

Clergy are a critical yet untapped resource in 
preventing and treating substance abuse and 
addiction. Priests, ministers, rabbis, imams and 
other religious leaders should become more 
engaged in addressing this problem, formally 
preaching about substance abuse issues and 
incorporating prevention and recovery messages 
into their ministry. Many people— especially 
Catholics and some Protestants-tum to their 
parish priest or minister for help in dealing with 
substance abuse problems. Schools of theology 
and seminaries— Protestant, Catholic, Rabbinical 
and others-should educate their students to 
recognize the signs of substance abuse and how 
to deal with them. Clergy should become 
familiar with treatment services available in 
their communities. 

Physicians and treatment providers should be 
better trained and informed of the importance of 
spirituality and religion to prevention and 
treatment of substance abuse and addiction, and 
of the spiritual and religious resources available 
in their local communities. In order to better 
meet the needs of their patients, physicians and 
substance abuse treatment specialists should 
discuss patients’ spiritual needs and desires and 



refer clients to appropriate clergy or spiritually- 
based programs to support their health and 
recovery. 

Finally, we need more research to better 
understand and enhance the complementary 
roles that religion and professional substance 
abuse treatment can play in prevention, 
treatment and recovery. 

We thank The Bodman Foundation and the John 
Templeton Foundation for the financial support 
that made this report possible. Joseph S. Dolan, 
Executive Director of The Bodman Foundation, 
encouraged us to explore the link between 
religion and substance abuse prevention and 
treatment. The contribution of the Templeton 
Foundation enabled us to expand our analysis. 
These combined contributions made it possible 
for CASA to conduct the first surveys of clergy 
and schools of theology and seminaries on the 
subject of substance abuse and addiction. 

Many individuals worked hard to produce this 
White Paper. Susan E. Foster, M.S.W., CASA’s 
Vice President and Director of Policy Research 
and Analysis, directed the effort. Peggy 
Macchetto, J.D. was the project manager. 

Emma Bemdt was the research assistant. David 
Man, Ph.D., CASA’s librarian. Ivy Truong, 
library research associate, and Barbara 
Kurzweil, library research specialist, were a big 
help. Margaret Usdansky, Susan Brody and 
John Muffler, Ph.D. contributed to the research 
effort. Jane Carlson, as usual, handled the 
administrative responsibilities. The thoughtful 
comments of Francis X. Clooney, S.J. of the 
Theology Department at Boston College and 
John Cecero, S.J. of Fordham University were 
especially helpful. 

David Larson, M.D., President of the 
International Center for the Integration of Health 
and Spirituality (formerly the National Institute 
for Health Care Research) and an Adjunct 
Professor in the Departments of Psychology and 
the Behavioral Sciences at Duke University 
Medical Center and Northwestern University 
Medical School served as a special consultant 
and made an invaluable contribution to this 
work. 




- 111 - 



8 



While many individuals and institutions 
contributed to this effort, the findings and 
opinions expressed herein are the sole 
responsibility of CASA. 




Chapter I 

Introduction and Executive Summary 

Ninety-five percent of Americans profess a 
belief in God. For many individuals, religion 
and spirituality are important components of 
prevention and treatment of substance abuse and 
of successful recovery. One has only to listen to 
the voices of recovery to hear how eloquently 
they speak about the role of religion or 
spirituality in their own healing process. 

CASA's research has identified an important 
connection between spiritual and religious 
practices and lower risk of substance abuse: 

• CASA’s annual teen surveys have 
consistently demonstrated that adolescents 
who attend religious services are less likely 
to report substance use.^ 

• CASA’s study, Under the Rug: Substance 
Abuse and the Mature Woman revealed that 
91 percent of woman over the age of 59 who 
did not identify themselves as religious 
consumed alcohol compared with 64 percent 
who identified themselves as Catholic and 
52 percent who identified themselves as 
Protestant. Similarly, mature women who 
say they are not religious are more likely to 
be current smokers (45 percent) than those 
who are Catholic (25 percent) or Protestant 
(21 percent).^ 

• Roughly one-third of prison inmates 
participates in religious activities and those 
who do so have been found to exhibit lower 
rates of recidivism.^ 



• CASA's CASASTART (Striving to Achieve 
Rewarding Tomorrows) parent program 
found that participating children had less 
past month drug use, delinquency and other 
problems, and that the most jfrequently 
attended activities were those sponsored by 
religious organizations."^ 




10 



These findings and experience have led CASA 
to explore in this White Paper the link the 
between God, religion and spirituality and 
substance abuse prevention, treatment and 
recovery, and how to better exploit any such 
link. By examining recent findings in practice 
and research with respect to the role of religion 
and spirituality in dealing with substance abuse 
and by listening to the voices of recovery, 

CASA aims to draw attention to a powerful 
source of hope for many affected by this disease. 

As part of this two-year study, CASA conducted 
two unprecedented surveys: one, asking 
presidents of schools of theology and seminaries 
about their perceptions of the extent of substance 
abuse problems and the formal training and 
coursework offered in this subject; the other, 
asking clergy in the field their perspective of 
these problems among their congregations and 
what training they had received in this area. 

CASA conducted its own special analyses of 
three national data sets: 1998 National 
Household Survey on Drug Abuse; CASA’s 
Back to School Surveys-5ac/: to School 1999- 
National Survey of American Attitudes on 
Substance Abuse V: Teens and Their Parents 
and National Survey of American Attitudes on 
Substance Abuse VI: Teens\ and the General 
Social Survey. CASA undertook an extensive 
review of more than 300 publications that 
examine the link between spirituality, 
religiousness and substance abuse and addiction. 
Finally, CASA looked at a wide range of 
programs that incorporate spiritual or religious 
components in their prevention or treatment 
programs. 

Most data and research on the link between 
substance.abuseandreligion.and .spirituality ^e_ 
limited to the Protestant and Catholic religions 
and to a lesser extent the Jewish faith. 
Unfortunately, we were unable to find any 
significant information in Islam, Buddhism or 
Hinduism. 



Key Findings 

• God, religion and spirituality are key factors 
for many in prevention and treatment of 
substance abuse and in continuing recovery. 

• Adults who do not consider religious beliefs 
important are more than one and one-half 
times likelier to use alcohol and cigarettes, 
more than three times likelier to binge drink, 
almost four times likelier to use an illicit 
drug other than marijuana and more than six 
times likelier to use marijuana than adults 
who strongly believe that religion is 
important. 

• Adults who never attend religious services 
are almost twice as likely to drink, three 
times likelier to smoke, more than five times 
likelier to have used an illicit drug other than 
marijuana, almost seven times likelier to 
binge drink and almost eight times likelier to 
use marijuana than those who attend 
religious services at least weekly. 

• Teens who do not consider religious beliefs 
important are almost three times likelier to 
drink, binge drink and smoke, almost four 
times likelier to use marijuana and seven 
times likelier to use illicit drugs than teens 
who strongly believe that religion is 
important. 

• Teens who never attend religious services 
are twice as likely to drink, more than twice 
as likely to smoke, more than three times 
likelier to use marijuana and binge drink and 
almost four times likelier to use illicit drugs 
than teens who attend religious services at 
least weekly. 

• Children who strongly believe that religion 
is important report learning more about the 
risks of drugs. When discussing drugs with 
their parents, 63.5 percent of teens who 
strongly believe religion is important feel 
they learned a lot about the risks of drugs; 
only 41 percent who believe religion is not 
important feel they learned a lot. 



n 

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- 2 - 



• College students with no religious affiliation 
report higher levels of drinking and binge 
drinking than those of either Catholic or 
Protestant religious affiliation. 

• Ninety-four percent of clergy members- 
priests, ministers and rabbis-recognize 
substance abuse as an important issue 
among family members in their 
congregations and almost 38 percent believe 
that alcohol abuse is involved in half or 
more of the family problems they confront. 

• Only 12.5 percent of clergy completed any 
coursework related to substance abuse while 
studying to be a member of the clergy and 
only 28.8 percent of presidents of schools of 
theology and seminaries report that 
individuals preparing for the ministry are 
required to take courses on this subject. 

• Only 36.5 percent of clergy report that they 
preach a sermon on substance abuse more 
than once a year; 22.4 percent say they 
never preach on the subject. 

• Seventy-nine percent of Americans believe 
that spiritual faith can help people recover 
from disease and 63 percent think that 
physicians should talk to patients about 
spiritual faith. One study found that 99 
percent of family physicians are convinced 
that religious beliefs can heal and 75 percent 
believe that prayers of others can promote a 
patient’s recovery. However, 74 percent of 
psychiatrists disapprove of praying with a 
patient; only 37 percent say they would pray 
with a patient even if provided with 
scientific evidence that doing so would 
improve patient progress. Only 57 percent 
would recommend that a patient consult 
with a member of the clergy. 

• Individuals who attend spiritually-based 
support programs, such as 12-Step programs 
of Alcoholics Anonymous and Narcotics 
Anonymous, in addition to receiving 
treatment are more likely to maintain 
sobriety. Individuals in successful recovery 



often show greater levels of faith and 
spirituality than individuals who relapse. 

Despite these facts, spirituality and religion are 
often overlooked as relevant factors in 
preventing and treating substance abuse and 
addiction. 

Next Steps 

Each religious and spiritual tradition has it own 
unique beliefs, commitments and rituals to bring 
to bear to minimize substance abuse and to aid 
recovery. To take advantage of the potentially 
positive benefits of religion and spirituality to 
prevent substance abuse and help individuals, 
CASA recommends a series of steps to combine 
the resources of religion and spirituality with 
those of science and medicine in order to 
enhance the prevention and treatment of 
substance abuse and to strengthen and maintain 
recovery: 

For the Clergy 

• Protestant, Catholic, Rabbinical and other 
schools of theology and seminaries should 
train clergy to recognize the signs and 
symptoms of substance abuse and know how 
to respond, including referral to treatment 
and strategies for relapse prevention. These 
schools should provide basic educational 
and clinical knowledge of the short and long 
term effects of tobacco, alcohol and other 
drugs and educate their students about ways 
to incorporate prevention messages both 
formally and informally into their work. 
They should educate their students about the 
co-occurrence of mental health and other 
problems (such as domestic violence and 
child abuse) and substance abuse. These 
schools should include courses related to 
substance abuse in degree requirements and 
provide in-service training for current 
clergy. 

• Clergy members who have completed their 
formal training should take advantage of 
additional substance abuse training in order 
to be knowledgeable about the topic. 



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. 3-12 



Resources include: local public substance 
abuse treatment agencies, private licensed 
substance abuse professionals, substance 
abuse professional organizations such as the 
National Association of State Alcohol and 
Drug Agency Directors (NASADAD), 
federal resources such as the National 
Institute on Drug Abuse and the National 
Institute on Alcohol Abuse and Alcoholism, 
the U.S. Department of Health and Human 
Services Substance Abuse and Mental 
Health Services Administration and its 
Centers for Substance Abuse Prevention and 
Substance Abuse Treatment. 

Members of the clergy should preach about 
substance abuse issues and informally 
include messages about the problem 
throughout their organization’s programs, 
services and counseling. Even religions 
with assigned readings and themes for 
sermons can incorporate messages about 
substance abuse as examples and prayers for 
those addicted in their services. 

Recognizing that substance abuse affects 
individuals and families in all congregations, 
clergy can inform their members with 
prevention messages, and help connect 
members of their community to needed 
intervention and treatment resources and, as 
many presently do, open their facilities to 
AA and NA meetings. 

Members of the clergy should reach out to 
treatment programs to offer spiritual support 
to individuals who desire such assistance. 
Clergy can help educate treatment providers 
of the promising effects of spirituality and 
religion in recovery. Clergy should learn 
about treatment programs in their 
comniunitie^ By building this relationship, 
clergy will know who to refer members to 
for treatment and know how to support 
referrals from treatment providers of clients 
seeking to deepen their spiritual life. 



individuals navigate these issues and benefit 
from a connection to a loving God and 
religious community. 

For Physicians and Treatment Providers 

For many individuals, spirituality and 

religiousness can be important companions to 

recovery and maintaining sobriety. 

• Physician and other health professions 
training programs should educate physicians 
and treatment specialists to understand that 
many patients desire spiritual help as 
complements to medical treatment, and the 
research documenting the benefits of 
spirituality and religiousness to physical and 
mental health. 

• Physicians and substance abuse treatment 
specialists should discuss patients’ spiritual 
needs and desires and, where appropriate, 
refer clients to clergy or spiritually-based 
programs to support their recovery. 

• Substance abuse treatment providers 
(physicians and other health clinicians) 
should establish working relationships with 
local clergy members not only to educate 
clergy members about substance abuse but 
also to better respond to patients needs and 
desires for a spiritual complement to their 
recovery regimen. 

Expand Our Current Knowledge Base 

• More research is needed to evaluate the 
efficacy and increase the effectiveness of 
faith-based prevention initiatives and 
treatment programs, develop better ways of 

-measiiring-adGlescent spirituality and - 
religiousness and document pathways 
through which religion and spirituality work 
to prevent substance abuse and aid in 
recovery. 



Participants in recovery may have great 
needs for spiritual guidance. Individuals 
struggling to recover may feel abandoned by 
God or alienated from God or the religious 
community. Clergy can help recovering 



13 




Chapter II 

What’s the Connection? 

Ninety-five percent Americans believe in 
God or a universal spirit. Adults and teens 
who believe that religion is important and 
who attend religious services frequently are 
less likely to use tobacco, alcohol and illicit 
drugs. Teens who never attend religious 
services are twice as likely to drink, more 
than twice as likely to smoke, more than 
three times likelier to use marijuana and 
binge drink and almost four times likelier to 
use illicit drugs than teens who attend 
religious services weekly or more. Adults 
who never attend religious are almost twice 
as likely to drink, three times likelier to 
smoke, more than five times likelier to use 
illicit drugs other than marijuana, almost 
seven times likelier to binge drink, and 
almost eight times likelier to use marijuana 
than adults who attend religious services 
weekly or more. Many recovering 
alcoholics and addicts report that their 
recovery is directly related to their religious 
beliefs and the social support of a 
community of believers. Increases in 
spirituality often go hand-in-hand with 
recovery. 

Religion and Spirituality: 
Defining Our Terms 

Religion is characterized by a set of 
particular beliefs about God or a higher 
power shared by a group of individuals, and 
the practices, rituals and forms of 
governance that define how those beliefs are 
expressed.^ Spirituality, on the other hand, 
is a deeply personal and individualized 
response to God, a higher power or an 
animating force in the world.^ One does not 
have to engage in religious rituals, belong to 
a church or even believe in God to be 
spiritual.^ 



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^ 14 



o 

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To determine the extent to which people are 
religious or spiritual, researchers use a 
variety of proxies: religious affiliation, the 
importance individuals attach to their 
religion, attendance at religious services."^ 
Identifying proxies for spirituality is more 
difficult because of its highly individual and 
personal nature. Such proxies include the 
extent of prayer or meditation, 
importance individuals attach to their 
spiritual life and personal statements 
linked to purpose in life and hope for the 
future.^ 

A Nation of Believers 

Ninety-five percent of American men and 
women age 1 8 and over believe in God or 
a universal spirit.^ According to the U.S. 
Census Bureau, 92 percent of the adult 
population is affiliated with some form of 
religion: 55 percent Protestant, 28 percent 
Catholic, two percent Jewish, six percent 
other.^ ^ More recent estimates from other 
sources suggest that two percent of the 
population is affiliated with the Muslim 
religion.^ ^ Nine out of 10 adults pray 
regularly and 43 percent attend church 
weekly or more.^ 

Women are more likely to report religious 
affiliation than men.^^ Of Protestants, 59.8 
percent are female and 40.2 percent are 
male. Fifty-six percent of Roman Catholics 
are female compared to 44.0 percent who 
are male. Of the Jewish faith, 53.0 percent 
are female and 47.0 percent are male. 
(Figure 2.A) Data on other religions show 
more males than females among Buddhists 
and Muslims, but national data on such 
groups are small and may not-be reliable. - 



* Age 1 8 and over. 

^ These numbers do not add perfectly to 92 
percent because of rounding. 

* During the past decade the Muslim community 
has grown substantially. The U.S. State 
Department and the American Muslim Council 
both estimate that the current population of 
Muslims in the United States is approximately 
six million or two percent of the population. 



Among those who claim no religious 
affiliation, 57.0 percent are male and 43.0 
percent are female.^ ^ On indices measuring 
spirituality, women have higher spiritual 
scores than men.^^ The fact that women live 
longer than men may be related in part to the 
fact that women report greater religious and 
spiritual affiliation. 



Figure 2.A 

Religious Affiliation by Sex 



Percent 80 
Affiliated 0 q 

40 
20 ] 
0 



59.8 



40.2 




44.0 



56.0 




47.0 



53.0 







Rotes tant 



Roman Catholic 



Jewish 



Source: CASA analysis of General Social Survey. 



□ Male 

□ Female 



Religiousness and religious affiliation vary 
by race. Those who identify themselves as 
white are 57.0 percent Protestant, 25.9 
percent Catholic, 2.5 percent Jewish and 3.3 
percent other religions. Those who identify 
themselves as black are 79.3 percent 
Protestant, 8.1 percent Catholic, 0.2 percent 
Jewish and 4.2 percent other religions. 
Eleven percent (1 1 .2) of those who identify 
themselves as white claim no religious 
affiliation compared to 8.2 percent who 
identify themselves as black. 

(Figure 2.1) 

Table 2.1 

Religious Affiliation by Race 



Percent 





Protestant 


Catholic 


Jewish 


Other ' 


None 


White 


57.0 


25.9 


2.5 


3.3 


11.2 


“Black - 


_ -79.3 - 


--..87- 


0.2- - 


- 4.2 


- 8.2 _ 



Note: Numbers may not add due to rounding. 
Source: CASA analysis of General Social Survey . 



15 



Adult Church Goers Use 
Substances Less 

CASA’s special analysis of National 
Household Survey data reveals that those 
age 18 and over who attend religious 
services are less likely to use tobacco, 
alcohol, marijuana and other illicit drugs 
than those who do not attend religious 
services. (Appendix A) Other research 
supports these findings. 

Alcohol 

Among adults, 116 million (55.5 percent) 
report using alcohol in the past 30 days.^^ 
Adults who never attend religious services 
are almost twice as likely to drink as those 
who attend religious services weekly or 
more often. Of those who attend religious 
services weekly or more often, 33.3 percent 
drank in the past 30 days compared to 50.2 
percent who attend religious services every 
other week and 64.7 percent who never 
attend religious services. 

Among adults, 33 million (15.9 percent) 
report binge drinking (consuming five 
drinks or more on one occasion) in the past 
30 days.^^ Adults who never 
attend religious services are 
almost seven times likelier to 
binge drink than are those who 
attend religious services weekly 
or more often. Of those who 
attend religious services weekly 
or more often, 3.5 percent binge 
drink compared to 9.7 percent 
who attend religious services 
every other week and 24.4 
percent who never attend 
religious services. (Figure 2.B) 

Tobacco 

Sixty million adults (28.7 percent) smoke 
cigarettes.* Those adults who never 
attend religious services are three times 



likelier to smoke than those who attend 
religious services weekly or more often. Of 
those who attend religious services weekly 
or more often, 13.5 percent smoke compared 
to 17.3 percent who attend religious services 
every other week and 40.8 percent who 
never attend religious services. (Figure 2.B) 

Illicit Drugs 

Almost 14 million adult Americans (6.9 
percent) use illicit drugs.^ Adults who 
never attend religious services are almost 
eight times likelier to have used marijuana 
in the past 30 days and more than five times 
likelier to have used another illicit drug than 
those who attend religious services weekly 
or more often. Of those who attend 
religious services weekly or more often, 1.1 
percent are current marijuana users 
compared to 1 .6 percent who attend 
religious services every other week and 8.1 
percent who never attend religious services. 
Of those who attend religious services 
weekly or more often, 0.7 percent use illicit 
drugs other than marijuana compared to 1 .1 
percent who attend religious services every 
other week and 3.8 percent who never attend 
religious services. (Figure 2.B) 



Percent 80 
60 
40 
20 
0 



Figure 2.B 

Adult Substance Use by Attendance at 
Religious Services 





64.7 











40.8 



3 


24.4 




*■ *> 






3.5 





□ Never Attend 

□ Attend Weekly or More 



13.5 



8.1 , , 



3-8 0,7 



Alcohol Binge Drink Tobacco Marijuana 



Source: CASA analysis of National Household Survey. 



Other Illicit 
Drugs 



* Smoking cigarettes in the past 30 days. 



^ Use in the last 30 days. 



When Religion is Important, 
Adult Substance Use is Lower 

Among adults, 45.7 percent strongly agree 
that their religious beliefs are important; 

40.8 percent agree that their religious beliefs 
are important, 10.3 disagree that their 
religious beliefs are important and 3.1 
strongly disagree that their religious beliefs 
are important. 

Alcohol 

Adults who do not believe that religious 
beliefs are important are more than one and 
one-half times likelier to use alcohol and 
more than three times likelier to binge drink 
than adults who strongly agree that their 
religious beliefs are important. Over 45 
percent (45.4) of those who strongly agree 
that their religious beliefs are important used 
alcohol in the past month compared with 
70.6 percent of those who strongly disagree 
that religious beliefs are important. Of those 
who strongly agree that their religious 
beliefs are important, 8.7 percent report 
binge drinking in the last month compared 
to 28.8 percent of those who strongly 
disagree that religious beliefs are important. 
(Figure 2.C) 



Tobacco 

Adults who do not believe that religion is 
important are more than one and one-half 
times likelier to smoke cigarettes than adults 
who strongly believe that religion is 



important. Of those who strongly agree that 
their religious beliefs are important, 22.2 
percent have smoked in the past month. Of 
those who strongly disagree that religious 
beliefs are important, 33.8 percent have 
smoked in the past month. (Figure 2.C) 

Illicit Drugs 

Adults to whom religion is not important are 
more than six times likelier to use marijuana 
and almost four times likelier to use other 
illicit drugs than those who strongly believe 
that religion is important. Of those who 
strongly agree that religious beliefs are 
important 2.2 percent have used marijuana 
in the past month compared to 13.8 percent 
who strongly disagree that their religious 
beliefs are important. Of those who strongly 
agree that religious beliefs are important, 1.5 
percent used other illicit drugs than 
marijuana in the last month compared to 5.6 
percent who strongly disagree that their 
religious beliefs are important. (Figure 2.C) 

The Protective Influence of 
Religion for Youth 

In CASA’s Back to School 1999— National 
Survey of American Attitudes on Substance 
Abuse V: Teens and 
Their Parents, 9.9 
percent of teens for 
whom religion is 
important had 
smoked marijuana 
sometime in their 
life vs. 21.5 percent 
of the teens who 
responded that 
-religion-was only a - 
little important in 
their life. A study in 
Miami Dade 
County, students who reported that religion 
was important to them were less likely to 
use cocaine and marijuana. They also 
were less likely to use cigarettes, but this 
difference was not statistically significant.^^ 



Percent 100 
80 
60 
40 
20 -I 
- -^0 



Figure 2.C 

Adult Substance Use by Belief in 
Importance of Religion 



70.6 



I./#' 



4 .. 



□ strongly Disagree Religion is Important 

□ Strongly Agree Religion is Important 



45.4 






28.8 



33.8 






8.7 



22.2 



13.8 



2.2 



5.6 



1.5 



Alcohol Binge Drink Tobacco Marijuana 
Source: CASA analysis of National Household Survey. 



Other Illicit 
Drugs 




17 



A survey of eligible students attending drop 
out prevention high schools found that those 
who attended church at least once monthly 
were significantly less likely to use 
marijuana or cocaine.^^ While some 
research was believed to support the idea 
that religiousness is relevant only to 
behaviors about which there are ambiguous 
societal norms (alcohol and cigarette use) 
and yet clear religious proscriptions, other 
research finds that high religiousness is 
correlated with lower illicit drug use among 
adolescents.^^ In a more recent study in 
Utah with a high Mormon concentration, 
students who were religious tended not to 
use drugs (alcohol, marijuana, 
amphetamines and depressants), although 
this relationship was not as strong for 
alcohol.^^ 

An older study in urban Atlanta and one in 
and around Los Angeles in the mid-1980s 
concluded that adolescents who were 
religious were less likely to use alcohol and 
drugs, and were less tolerant of their use.^"^ 



important; 47.5 percent agree; 13.5 percent 
disagree; and 3.8 percent strongly disagree 
that their religious beliefs are important. 

Teens who never attend religious services 
are twice as likely to drink, more than twice 
as likely to smoke, more than three times 
likelier to use marijuana and to binge drink, 
and almost four times likelier to use illicit 
drugs than teens who attend religious 
services weekly or more. Teens who do not 
believe that religious beliefs are important 
are almost three times likelier to drink, binge 
drink and smoke, almost four times likelier 
to use marijuana and seven times likelier to 
use illicit drugs than teens who strongly 
believe that religious beliefs are important. 

Alcohol. Close to one in five (19.1 percent) 
teens (aged 12 to 17) have used alcohol in 
the past 30 days. Of teens who attend 
religious services at least weekly, 1 1.9 
percent have used alcohol in the past 30 
days compared to 15.2 percent who attend 
religious services every other week and 24.5 
percent who never attend religious services. 



In another study, personal devotion (a 
personal relationship with the divine) among 
adolescents and affiliation with more 
fundamentalist religious denominations 
were linked to lower rates of substance use 
and abuse across a range of drugs (alcohol, 
marijuana, cocaine and others), and a 
personal commitment to teaching and living 
according to a religious creed 
was linked to less use of 
alcohol 

Teen Religious Attendance 
and Beliefs Equal Lower 
Use 

CASA’s analysis of the 
National Household Survey 
data reveals that attendance at 
religious services and belief 
that religion is important are linked to lower 
rates of substance use among youth.^^ 
(Appendix B) Among teens, 35.2 percent 
strongly agree that their religious beliefs are 



Among teens, 7.5 percent report binge 
drinking in the past 30 days. Of those who 
attend religious services at least weekly, 3.0 
percent binge drink compared to 5.6 percent 
who attend religious services every other 
week and 10.4 percent who never attend 
religious services. (Figure 2.D) 



Of teens who strongly agree that their 
religious beliefs are important, 12.2 percent 
have used alcohol in the past month 
compared to 33.8 percent of those who 



Rgure 2.D 

Teen Substance Use by Attendance at 
Religious Services 




Alcohol Binge Drink Tobacco Marijuana Other Illicit 



Source: CASA analysis of National Household Survey. 




-9- 



18 



strongly disagree that their religious beliefs 
are important. Less than five percent (4.6 
percent) of those who strongly agree that 
their religious beliefs are important report 
binge drinking in the last month 
compared to 13.3 percent of those 
who strongly disagree that their 
religious beliefs are important. 

(Figure 2.E) 



14.0 percent who strongly disagree that their 
religious beliefs are important. 

(Figure 2.E) 



Rgrcent 40 



Figure 2.E 

Teen Substance Use by Belief in Importance 
of Religion 



Tobacco. Approximately 18.3 
percent of teens smoke. Of those 
who attend religious services weekly 
or more often, 11.8 percent smoke 
compared to 13.1 percent who attend 
services every other week and 26.0 
percent who never attend religious 
services. Of those who strongly 
agree that their religious beliefs are 
important, 1 1.0 percent have smoked in the 
past month compared with 30.9 percent who 
strongly disagree that their religious beliefs 
are important. (Figures 2.D and 2.E) 

Illicit Drugs. Eight percent (8.3) of teens 
have smoked marijuana in the past 30 days 
and four percent have used some other illicit 
drug. Of teens who attend religious services 
at least weekly, four percent have smoked 
marijuana in the past 30 days compared to 
five percent who attend services every other 
week and 12.4 percent who never attend 
religious services. Two percent (2.1) of 
teens who attend religious services weekly 
or more have used illicit drugs other than 
marijuana in the past 30 days compared to 
1.7 who attend every other week and 8.2 
who never attend religious services. 

(Figure 2.D) 

Of teens-who strongly agreejhat their_ 
religious beliefs are important, 4.5 percent 
have used marijuana in the past month 
compared to 16.9 percent who strongly 
disagree that their religious beliefs are 
important. Two percent of those who 
strongly agree that their religious beliefs are 
important have used other illicit drugs than 
marijuana in the last month compared to 

* Smoked a cigarette in the past 30 days. 



30 



20 - 



10 



33.8 






30.9 



12.2 



13.3 



Ju 

fit 



4.6 






□ Strongly Disagree 

Religion is Important 

□ Strongly Agree 

Religion is Important 



16.9 



11.0 



P--- 

m 



14,0 



4.5 



r-' 

‘j; ‘..7. 



2.0 



Alcohol Binge Drink Tobacco Marijuana Other Illicit 



Source: CASA analysis of National Household Survey. 



Drugs 



Religious Teens Learn More About 
Drug Risk from Parents 

Children for whom religion is important 
report learning more about the risks of 
drugs. When discussing drugs with their 
parents, 63.5 percent of teens who strongly 
believe religion is important feel they 
learned a lot about the risks of drugs; only 
41 percent who believe religion is not 
important feel they learned a lot.^^ 

Religious Engagement Lowers 
Risk for College Drinking 

Religiousness is an important predictor of 
substance use among college students.^^ In 
a large national sample of the drinking 
patterns and problems of college students, 
heavy drinkers were more likely to be men, 
whites and Roman Catholics to whom 
religion is not important.^ 

College students who describe themselves as 
religious are more likely to exercise more 
control over their drinking.^^ College 

^ They are also more likely to be individuals with 
low grade point averages, fraternity members 
and attending colleges in the northeast of under 
10,000 students. 



er|c 



•‘"19 



students with no religious affiliation report 
drinking greater amounts more frequently, 
getting drunk more often, more celebratory 
reasons for drinking and perceptions of more 
college drinking than those of either 
Catholic or Protestant religious affiliation. 
However, alcohol addiction was not found 
to be significantly different across these 
groups.^^ 

Although college students who are members . 
of religions that prohibit use of substance 
use them less, they do not ascribe their 
religion as the only motivation for less use. 

In a targeted sample of Seventh Day 
Adventists in college, 87 percent listed harm 
as the most important reason for abstaining 
from alcohol, followed by being in control 
(84 percent) and basic religious commitment 
(73 percent). Cost, friends, fear of parents 
and legality were last.^^ 

Although less data exist on the relationship 
of belief in God or spirituality to college 
students’ illegal drug use, college students 
who respond that religion is not very 
important exhibit higher rates of marijuana 



Religion, Spirituality and Health 

Beyond the link between belief in God, 
religious affiliation, spirituality and 
substance abuse, medical and social 
scientists have amassed a sizeable body of 
research demonstrating the beneficial effects 
of religion on a wide range of mental health 
measures, including depression, anxiety, 
coping with stress and personal well-being. 
Studies also have identified beneficial 
effects of religion and spiritual commitment 
on physical health, including life 
expectancy. Persons who regularly 
participate in religious activities appear to 
live longer compared with those who report 
less religious involvement. An analysis of 
42 studies involving 1 26,000 people found 
that active religious involvement increased 
the chance to live longer by 29 percent.^"^ 
Studies have demonstrated that religiously 



involved individuals are less likely to have 
high blood pressure or be depressed. Such 
individuals may have a faster recovery rate 
should depression occur.^^ Elderly women 
and men who regularly attend church 
services and activities have healthier 
immune systems than those who stay at 
home, while those affiliated with religious 
communities are associated with lower use 
of hospital services.^^ 

Meditation, common in both religious and 
spiritual traditions, has been correlated with 
a variety of positive health outcomes 
including lowering blood pressure,^^ 
reducing chronic pain,^^ even a reduction in 
blood cholesterol levels.^^ Among patients 
with cancer, religious beliefs are associated 
with reduced levels of pain and anxiety."^° 
Cancer survivors who engage in spiritual 
practices tend to exhibit more positive health 
habits and provide more social and 
emotional support to other survivors."^* 

The benefit of religion seems to be linked to 
a nurturing and supportive religiousness 
rather than one that is “restrictive, 
negativistic and ritualistic.”'^^ 



ERIC 



- 11 - 20 



Chapter III 

How Do Religion and Spirituality Influence 
Substance Use? 



An individual may be less likely to use 
substances because the religious or spiritual 
community of which they are a part expresses 
direct prohibitions and limitations against use or 
abuse. Alternatively, participation in a 
community sharing the same faith or spiritual 
practice may provide a sense of acceptance and 
belonging, minimizing the need to turn to 
addictive substances and providing support in 
resisting them. Or, individuals may be less 
likely to use substances because their personal 
connection with a higher power fills a need that 
makes substance use unnecessary or provides 
hope for the future and strength to resist the 
opportunity to use substances. 

Proscriptions from Religious 
Groups 

Denominations of Judaism and Christianity 
prohdbit or restrict substance use in some way, as 
do other religions such as Islam and Eastern 
religions. These religions and denominations 
vary in the scope and strictness of their 
prohibitions. 

Judaism, one of the earlier historical traditions, 
is based on the belief in one transcendent God 
who revealed Himself through Abraham, Moses 
and later prophets. Teachings of Judaism are 
based on the written texts of the Torah, the 
Talmud and Old Testament. Judaism expects 
moderation of alcohol and no use of substances 
except tobacco.^ 



Do not join those who drink too much 
wine or gorge themselves on meat. 



Similarly based on the notion of one God, 
Christianity is a religion that grew out of 
Judaism and is based on the teachings of Jesus 



—Proverbs 23:20 



ERIC 



-13- 




Christ as recorded in the New Testament of the 
Bible. Early Christians (later Roman Catholic 
and Orthodox churches) inherited the Jewish 
position on substance use, only urging believers 
to exercise control without requiring abstinence 
and retaining the traditions of wine within 
rituals. 

Although there is no blanket condemnation or 
connotation of sin for the use of alcohol in the 
Jewish or Christian scriptures, there is a clear 
and definitive admonition against drunkenness- 
using alcohol in a way that is harmful and causes 
impairment.^ For example, in the Old Testament 
(Genesis 20:29-36), the story of Lot after the fall 
of Sodom and Gomorrah associates drunkenness 
with incest. Later in the New Testament, the 
Apostle Paul in his letter to the Romans 
(Romans 13:13) advises: “Let us conduct 
ourselves becomingly as in the day, not in 
reveling and drunkenness,” and Paul’s first letter 
to the Corinthians (I Corinthians 5:11) says: 

“But rather I wrote to you not to associate with 
any one who bears the name of brother if he is of 
immorality or greed, is an idolater reviler, 
drunkard or robber.” These Old and New 
Testament teachings stress that the individual 
cannot abuse alcohol and live a God-centered 
spiritual life. Within certain religious traditions, 
violations of the interpretations of these 
passages opposing drunkenness may be defiant 
of God or interpreted as a misuse of fi’eewill and 
thus sinful.^ 

In 1999, the Vatican issued a paper stating that 
Catholics who forego smoking or drinking 
alcohol are “doing a partial penance that will 
help purify them and prepare them for the 
afterlife.”"* 



Deacons, likewise, are to be men worthy of 
respect, sincere, not indulging in much wine, 
and not pursuing dishonest gain. 

—Timothy 3:8 



In response to the political activities of Europe 
in the 16* and 17* centuries, Christian 
Protestant religions were formed breaking away 
fi-om the central authority of the Pope and 



focusing on Scripture alone. Protestants were 
the largest influence on the temperance 
movement. In the 1800s, Methodists, 
Presbyterians, Society of Friends and Baptists 
officially adopted policies calling for their 
members to refi-ain fi-om use of alcohol.^ In the 
19* century, newly developing American 
religions like the Church of Latter Day Saints 
and Seventh Day Adventists adopted these 
measures and joined the political and social 
temperance movement; some have moved 
beyond proscriptions against alcohol and other 
drugs, abhorring chemical and pharmaceutical 
interventions.^ As medicines developed, most 
Christian denominations permit use of 
pharmaceuticals for therapeutic purposes’ but 
discourage abuse. 

Similar to Judaism and Christianity, Islam is 
based on a belief in one God (Allah) and the 
teachings as revealed to Allah’s prophet, 
Mohammed. The teachings of Islam are 
concentrated in the Koran and the Sharia. Islam 
has the most stringent proscription: use of 
alcohol and other intoxicating substances is 
forbidden.^ Islam has always been critical of 
Christianity's tolerance of alcohol. “It has been 
argued that The Prophet viewed alcohol as the 
primary cause of hatred, violence and other evils 
that kept pre-Islamic society weak, divided and 
cursed....”^ The interpretation of this prohibition 
varies among Islamic countries. 

Among Eastern religions, Hinduism and 
Buddhism speak to the topic of substance use 
and abuse. Hinduism is both a civilization and a 
religion. The term, Hinduism, encompasses the 
Indian civilization of approximately the past 
2,000 years, which grew out of Vedism, the 
religion of the Indo-European peoples who 
settled in India in the last centuries of the second 
millenium B.C. Hinduism has no formal date of 
beginning or founder, nor does it have a central 
authority, hierarchy or organization. As a 
religion, Hinduism has an array of doctrines and 
ways of life.' ° Traditional Hindu texts contain 
warnings about the dangers of drunkenness. For 
example. The Laws of Manu state that “[among 

those to be avoided are]. . .a drunkard The 

South Indian moral classic. The Tirukkural, 
warns that “A wine lover strikes no fear in his 



foes/ And his glory wanes. Drink no wine, or let 
them drink it/Who care not what wise men 
think.”'^ 

Both a religion and philosophy, Buddhism 
originated in northeastern India between the late 
sixth century and the early fourth century B.C. 
and developed from the teachings of the Buddha 
Gautama (or Gotama)— the original teacher and 
revealer of Buddhist truth. Warnings against 
substance use and abuse can be found in 
Buddhist texts. The Vyaggahapajja contains a 
section on the “Duties of Lay Followers'’ that 
includes among “Six things leading to loss of 
wealth which are to be avoided: addiction to 
drinking liquor. . Buddhist monks and laity 
vow to refrain from indulging in alcohol. For 
example, one version of a vow taken by 
Buddhist monks and laity reads: “I undertake the 
rule of training to refrain from distilled and 
fermented drinks and from drugs that cause 
carelessness.”*^ 



The Amish in this northeast Ohio city have 
long struggled to curb underage drinking in 
their community. The problem has been 
serious enough that despite their tradition of 
avoiding the outside world, Amish leaders 
reached out to police and judges in recent 
years for help breaking up drinking parties 
and doling out tough sentences to offenders. 
While the number of alcohol-related arrests 
now appears to be down, authorities say the 
problem remains?^ 

“Associated Press 
May 22, 2000 



Religious Sanctions Reduce Substance Use 

Religious proscriptions provide guidelines for 
behavior.*^ An individual who violates a 
religious prohibition against substance use may 
incur some type of sanction. Sanctions can 
range from ostracism from the group, physical 
punishment or threats of incurring the 
displeasure of God. Research has shown that 
individual conduct is affected by such 
sanctions.*^ 



The strength of the proscription and its 
subsequent effect varies by religious affiliation. 
Fundamental Protestants with more stringent 
proscriptions against drinking are less likely to 
use substances or be heavy drinkers than 
Catholics or other Protestants.*^ In a study of 
religious proscription in three faith groups- 
proscriptive, moderation and nonproscriptive — 
the proscriptive groups reported lower alcohol 
use, while the nonproscriptive groups showed 
higher alcohol use.^ Religious proscription did 
not, however, have a significant impact on binge 
drinking.*^ 

While formal proscriptions affect substance use, 
religion also may contain broad messages that 
support antisubstance abuse themes. Individuals 
who believe they are creatures of God, made in 
His image and those who believe they are 
endowed by God with special dignity are likely 
to consider behavior that undermines or 
devalues that dignity or health, including 
substance abuse, as violating the sanctity of 
divine creation.^* 

The Paradoxical User 

Within religious groups that prohibit use is the 
phenomenon of the paradoxical user—an 
individual who uses substances despite 
prohibitions.^^ The paradox is that such users 
may be prone to heavy or problem use.^^ Within 
a proscriptive religious culture, substance users 
may become further isolated, contributing to a 
downward spiral into substance abuse and 



* For this study, religious proscriptiveness was 
measured through three types of faith group s— 
proscriptive group (i.e.. Baptist, Pentecostal and 
Mormon), moderate group (i.e., Methodists and 
Presbyterian) and nonproscriptive group (i.e., 
Lutheran, Episcopal, Jewish, Eastern Orthodox and 
Roman Catholic). 

^ The researchers used a scale of 0 to 3 representing 
no use up to use on 20 occasions or more in the past 
year. The mean alcohol use of the proscriptive group 
was 1.27 and the mean alcohol use of the 
nonproscriptive groups was 1.62. A similar scale 
was used for binge drinking; using a scale of 0 to 5, 
representing no occasions of binge drinking up to 
binge drinking 10 or more times over the past two 
weeks. 



addiction.^'* The paradoxical user illustrates that 
substance abuse does not spare any group from 
its devastating impact. 

The Supportive Role of the 
Religious/Spiritual Community 

Participation in a social network that shares 
common religious and spiritual beliefs also 
affects substance use and abuse. Messages from 
parents, adolescent peers and fellow adults affect 
individuals’ spirituality and religiousness and 
their behavior related to substance use. These 
social networks offer support, models and 
informal positive and negative reinforcement. 

Family 

Parents and family are the first link children 
have to learning the rules of society and of the 
religion^^ and family religious values have a 
protective effect for youth. The father’s belief in 
God in particular has a significant effect on the 
substance use behavior of adolescent girls.^® 

Like all adults, parents’ church attendance is 
linked to less frequent use of alcohol, marijuana 
and other drugs, as well as more negative 
attitudes towards use of these substances.^’ 
Parental substance use, including smoking, 
drinking and illicit drug use, are associated with 
children's substance use.’^ Teens who do not 
drink are less likely to report frequent parental 
drinking.’® 

Healthy psychological attachments and bonding 
to parents also are factors contributing to 
lowered substance use. Parents who are 
religious are more likely to monitor their 
children’s behavior and to bond (particularly the 
mother) with their children.’® CASA’s Teen 
Surveys reveal that teens are more likely to be 
religious if their parents are religious and are 
more likely to attend religious services if their 
parents do so.’* Likewise, teens whose parents 
consider religion to be important are less likely 
to use drugs.” 



Peers 

Peer may influence each other toward 
conformity in behavior (peer pressure) or peers 
may seek out others who share similar behavior 
(peer selection). Teens use substances in ways 
similar to their peers and teens may seek out 
peers who share substance use patterns.” 
Religiousness also follows these paths. Peers 
may adopt religious beliefs and practices similar 
to those around them; and peers may seek out 
others who already share these beliefs. CASA’s 
teen survey has shown that teens who say none 
of their friends regularly attend religious service 
have four times the risk of substance use than 
teens who say most or all of their friends 
regularly attend religious services.’® Other 
research shows that students who are religious 
tend not to use drugs and not to have close 
friends who use drugs (alcohol, marijuana, 
amphetamines and depressants).” 

Many other factors are at work in the 
relationship between youth, religiousness and 
spirituality and substance use. For example, 
adolescent substance users have a greater 
likelihood of involvement in delinquent 
activities, tend to have lower self-esteem and be 
less religious.’* Also, adolescent girls 
(compared to boys) and older youth (17-year 
olds compared to 12-year olds) are more likely 
to be aware of a contradiction between drug use 
and religion.” Consequently, if they decide to 
use drugs they are more likely to step away from 
religion.” 

Adult Social Networks 

While research often focuses on peer groups of 
youth, social networks also play a role in the life 
of adults. Adults who are connected to some 
type of community or social network have lower 
rates of substance abuse.’® Religious and 
spiritual groups provide an identifiable social 
network for adults®® which can serve as a 
protective factor in both prevention and 
recovery. These networks can provide a sense 
of belonging and purpose. 





- 16 - , 



How Has Recovery Impacted Your 
Spirituality? 

It's gone from not believing to saying 
prayers, to talking to God not just about 
problems lam having. The only time 
when I was drinking when I would talk to 
God was "Please don 't let me die 
because I drank so much. ... And now 
that is not the case. Things always come 
up and I ask for help but at the same 
time I can also thank God for making a 
good day happen too. So it 's working 
both ways.^^ 

-Ed 

44-year old Caucasian Male 



Ethnicity also may be associated with protective 
or risk-enhancing effects on substance use and 
abuse. Studies in the 1970s have shown that 
among regular drinkers in America, Irish 
Catholics, white Anglo-Saxon Protestants, Slavs 
and Native Americans tend to drink more 
heavily than the rest of American society. This 
research also found that Irish Catholics are far 
less likely to abstain from alcohol than many 
other ethnic groups and are therefore more likely 
to have alcohol-related problems."^^ 

Alcoholics Anonymous with its 12-Step 
program (see Chapter V), is the largest and most 
extensive spiritually-based recovery program. 
But it also serves to provide thousands of social 
networks. Individuals who participate in a 12- 
Step program provide critical social support to 
each other. In this sense, the effects of 12-Step 
programs may go beyond the spirituality 
component as participants may be influenced by 
the process and dynamics of the group itself."^^ 
For example, in a study at a treatment facility, 
the majority of residents (53 percent) attending 
weekly Alcoholics Anonymous (AA) meetings 
claimed that a sense of fellowship with other 
recovering participants was their primary reason 
for program involvement. Among men living in 
a communal setting with other recovering 
addicts, the need for social support for 
continuing sobriety was important beyond the 
confines of their residence. Social support was 
a significant factor in a study of 125 sober 



female alcoholics and was directly related to 
their sense of power to change their lives."*^ 

Twelve-Step programs vary in quality and 
culture, making it difficult to generalize about 
the programs overall. Although these groups 
function under the same tenets, group dynamics 
create unique environments in each setting and 
some leave these groups finding them too 
authoritarian.'*^ 

Other social networks result as a product of 
physical location'*^ such as prisons. Eighty 
percent of those within the prison system are 
there because of offenses related to substance 
abuse (e.g., violated drug or alcohol laws, 
convicted of a DUI, under the influence of drugs 
and/or alcohol during the crime that led to 
incarceration, stole money for drugs or had a 
history of substance abuse).'*^ Participation in a 
spiritual or religious program can provide 
inmates struggling with addiction with formal 
and informal social support. 

Direct Connection to a Power 
Greater Than Self 

Individuals frequently report that a connection to 
God and religion is part of their recovery from 
substance abuse.'*^ They also report that a lack 
of such a relationship contributed to the 
escalation of their problem.^^ Two hundred 
males admitted into residential treatment 
programs were surveyed to establish the extent 
of their spiritual needs while in treatment: 63 
percent wanted to feel close to God, 30 percent 
missed the comfort they once enjoyed from 
religion and 39 percent reported that their 
addiction keeps them from God.^* Interviews 
with recovering individuals reflect a positive 
correlation between their relationship with God, 
spirituality and their recovery For example, in 
a study of 62 addicts and a control group, 
recovering individuals scored higher on 
measures of spirituality.^^ 

A relationship with God or a higher power can 
provide a person with a sense of security and 
stability. A spiritual experience may produce a 
psychological and/or physical reaction that 




-17- 



25 



satisfies particular spiritual, physical and mental 
needs. 



26 




- 18 - 




Chapter IV 

The Role of the Clergy 

CASA’s unprecedented survey reveals that 94 
percent of clergy members recognize substance 
abuse as an important issue among family 
members in their congregations. Almost 38 
percent believe that alcohol abuse is involved in 
half or more of the family problems they 
confront; yet only 12.5 percent of clergy 
completed coursework related to substance 
abuse while studying to be a member of the 
clergy and only 25.8 percent of presidents of 
schools of theology, including seminaries, report 
that persons preparing for the ministry are 
required to take courses dedicated to this 
problem. Only 36.5 percent of clergy preach a 
sermon on substance abuse more than once a 
year. 

Many Substance Abusers Turn to 
Clergy for Help 

During the past eight years, Georgetown 
University’s Woodstock Theological Center has 
administered questionnaires to Catholic clergy 
participating in its retreats focused on improving 
preaching. The responses show near unanimity 
in identifying addiction as one of the three most 
problematic social issues they are called upon to 
deal with in their parishes.^ The substance most 
commonly identified was alcohol. Reasons 
people give for turning to the clergy for help 
with substance abuse problems include: greater 
access to the clergy than health care 
professionals, less or no expense for help and 
preexisting relationship with members of the 
clergy.^ 

To better understand the current state of 
preparation and training of the clergy and their 
perception of the relative importance of 
substance abuse as an issue in the lives of their 
congregations, CASA developed two brief 
surveys. (Appendix B) One was distributed to a 
sample of 1 ,200 current clergy asking their 
perception of the extent of the problem, the 





nature and extent of their training related to 
substance abuse and the frequency of formal 
public dialogue about substance abuse issues/ 

A second survey was distributed to presidents of 
schools of theology (including seminaries) 
seeking their perception of the extent of 
problems related to substance abuse among the 
congregations and communities their students 
would eventually serve and of formal training 
and coursework related to the problem/ The 
surveys were sent by CASA so those receiving it 
were aware of the interest of this organization. 



* A sample of 1,200 active parish clergy was selected 
from four geographically representative areas of the 
nation: New York, Florida, Iowa and Washington. 
The choice of these states provided a blend of urban, 
suburban and rural communities. For purposes of 
analysis, denominations were grouped as follows: 
Catholic, Protestant, Jewish, Christian Orthodox 
(e.g., Greek Orthodox) and Other (Independent and 
Nondenominational Churches). Given the wide 
variation in both print and online denominational 
directories, the survey sample was drawn from 
among parishes, congregations and synagogues with 
current websites, with special attention paid to less 
populated and underserved areas. These surveys 
were mailed November 1999, and respondents were 
given the option to return the questionnaire either by 
mail or fax. We received 320 responses (26.6 
percent). 

^ The questionnaire was mailed November 1999 to 
the presidents of the 230 multidenominational 
Christian seminaries in the United States, Puerto Rico 
and Canada that are accredited members of the 
Association of Theological Schools (ATS), and six 
Rabbinical Schools representing the major streams of 
American Judaism (Orthodox, Conservative, Reform 
and Reconstructionist). ATS is the accrediting body 
for seminaries, with standard criteria governing 
degree programs and pastoral training. Its 
membership is nationally and denominationally 
representative. Similar organizations and-institutions 
for Muslim clerics were not found. As a result, this 
study lacks their perspective and experience. For 
purposes of analysis, denominations were grouped as 
follows: Catholic, Protestant, Jewish, Christian 
Orthodox ( e.g., Greek Orthodox) and Other 
(Independent and Nondenominational Churches). 
Among the schools responding to the survey 23 were 
Catholic, 81 Protestant, 4 Jewish, one Christian 
Orthodox and 16 Other. Respondents were given the 
choice to reply either by fax or by mail. 125 surveys 
were returned (54.3 percent). 



Clergy: Substance Abuse an 
Important Problem 

Almost all clergy responding to the survey 
indicated that substance abuse was an important 
issue. Ninety-four percent (94.4) of those 
surveyed consider substance abuse to be an 
important issue that they face; 51.9 percent 
consider it to be very important; 42.5 percent, 
somewhat important. Less than five percent 
(4.4) responded that substance abuse is not an 
important problem and 1 .3 percent did not know. 
Approximately 70 percent (69.2) of the Catholic 
clergy consider substance abuse a very 
important issue among their congregations, 
compared to 54 percent of Protestant clergy, 

47.4 percent of Orthodox Christian clergy, 35 
percent of Jewish clergy and 43.8 percent of 
other clergy. 

Almost 38 percent (37.9) find alcohol abuse 
involved in half or more of the family problems 
they confront. Thirty percent (29.5) find alcohol 
abuse implicated in up to three-quarters of the 
family problems they face; 8.4 percent find 
alcohol abuse involved in 75 percent or more of 
such problems. Another 27.3 percent indicated 
25 percent to 49 percent of family problems 
relate to alcohol abuse. Thirty-five percent 
(34.7) indicated that less than 25 percent of the 
family problems they face involved alcohol 
abuse. 

Virtually all (97.6 percent) of the presidents of 
schools of theology and seminaries rated 
substance abuse as very important (59.2 percent) 
or somewhat important (38.4 percent). Only one 
respondent replied that the issue was not 
important and two do not know. Among the 
presidents of the Catholic schools, 73.9 percent 
sav/ the problem as verj^ important and 26. 1 
percent as somewhat important. For Protestant 
presidents the responses were 58.2 percent and 

40.5 percent respectively; Jewish 50 percent for 
each, and among other religious groups 56.3 
percent and 43.7 percent respectively. 

(Figure 4.A) 



ERIC 



- 20 - 



28 



required to take any course 
dedicated to substance abuse. The 
required number of credits for the 
one-quarter of schools with such 
required courses ranged from one 
to nine: 8.3 percent require only 
one credit, 44.4 percent require 
three credits, 22.2 percent require 
nine credits. 



More than a quarter of 
respondents said that students can 
elect to take courses in substance 
abuse or that the issue may arise 
in their required field work. 
Students could be exposed to 
substance abuse issues during 
field work assignments, but the 
nature of this exposure and the 
extent of instruction related to 
substance abuse through this 
experience is unclear. 



Two-thirds (65.3 percent) of 
clergy indicated that they had 
sought training on their own to 
assist parishioners seeking help 
with alcohol or drug abuse and 
addiction since ordination: 70.1 



Few Clergy Members Trained to 
Address Substance Abuse 

Overall, only 12.5 percent of clergy members 
completed any coursework related to substance 
abuse while studying to be a member of the 
clergy. Orthodox Christians (27.8 percent) were 
slightly more likely to have completed substance 
abuse-related coursework, followed by Catholics 
(17.9 percent), Protestants (13.1 percent), Jewish 
(2.3 percent) and other (6.3 percent). 

(Figure 4.B) 

Just over a quarter (28.8 percent) of schools of 
theology and seminaries require individuals 
preparing for ordained ministry to take any 
courses dedicated to providing information or 
pastoral counseling training about the nature and 
consequences of alcohol and drug abuse and 
addiction. Over 70 percent (71 .2) admitted that 
individuals preparing for the ministry were not 



O 




of percent Protestant clergy, 65.8 percent of 
Catholic clergy, 63.2 percent of Orthodox 
Christians, 48.8 percent of Rabbis and 68.8 
percent of other clergy. (Figure 4.C) 



As my congregation grew, I set up a professional 
counseling service within the church. I was 
shocked when I discovered the extent of the 
substance abuse problems in my congregation and 
how closely linked it is to sexual abuse, eating 
disorders and family violence. I now preach about 
substance abuse, deal with it in adult Bible study 
groups and in our youth groups. 

—Protestant Minister 
Arizona 



Rgure 4.A 

Presidents of Schools of Theology Rate 
Importance of Substance Abuse 




Figure 4.B 

Clergy Members Who Completed Coursework on 
Substance Abuse in Theology School 



Percent 




Source: CASA Clergy Survey. 



- 21 - 



29 



Figure 4.C 

Clergy Who Sought Training on Their Own on 
Substance Abuse 

Percent 

Responding 80 
60 
40 
20 
0 

Source: CASA Qergy Survey. 




Rotestant Catholic Orthodox Jew ish Other 
Christian 



Figure 4.D 

How Often Clergy Preach About 
Substance Abuse 



percent say they preach such a 
sermon annually; 23 percent say 
every couple of years. More than 
20 percent (22.4) never preach a 
sermon on the topic. (Figure 4.D) 

Among responding clergy who 
considered substance abuse a very 
important problem, 5 1 percent say 
they preach a sermon about 
substance abuse more than once a 
year, but 15.3 percent had never 
preach such a sermon. Of the 
remainder, 19.1 percent say they 
preach annually; 14.6 percent, 
every couple of years. 

(Figure 4.E) 




Source: CASA Qergy Survey. 



CASA believes the estimates of 
the percent of clergy who 
actually preach on the subject of 
substance abuse are likely over 
estimates. Those responding to 
the survey were more likely to be 
those who consider substance 
abuse to be an important 
problem. 



Rgure4.E 

How Often Clergy Who Consider Substance Abuse 
Very Important Preach About Substance Abuse 




Once a Y ear of Y ears 

Source- CASA-Qergy Survey. 



This disconnect between 
preaching and the problem-- 
between knowledge of the 
importance of substance abuse to 
congregations and the limited 
extent to which it is addressed 
from the pulpit-is troubling and 
may in part be due to the lack of 
training. While virtually all 
schools considered substance 
abuse a problem, three-fourths 
(74.2) do not require any training 
in this area. 



The Disconnect Between Preaching 
and the Problem 



Despite recognition by more than nine of 10 
clergy of the importance of substance abuse to 
the families of their congregations, only one in 
three (36.5 percent) say they preach a sermon on 
the subject more than once a year. Another 18.1 



30 




- 22 - 




Chapter V 

Prevention, Intervention, Treatment and Recovery 

Seventy-nine percent of Americans believe that 
spiritual faith can help people recover from 
disease and 63 percent think physicians should 
talk to patients about spiritual faith.' In spite of 
American’s desires and expectations that 
spirituality and prayer be included in the 
treatment process, little research exists 
documenting effective ways that religion and 
spirituality can be incorporated into substance 
abuse prevention or intervention, few program 
models exist and no rigorous evaluations have 
been conducted. Research has shown, however, 
that treatment programs that incorporate 12- 
Step, spiritually-based components can show 
better treatment outcomes than those devoid of a 
spiritual base. 

Prevention 

While belief in the importance of religion, 
attendance at religious services and participation 
in spiritual practices are associated with lower 
rates of substance use, practically no research is 
available to guide how religion and spirituality 
may be employed in effective prevention 
programs. CASA reviewed a wide range of 
substance abuse prevention programs to identify 
those that incorporated religious or spiritual 
components and had been evaluated to 
determine the impact of those components on 
prevention. We were disappointed to find no 
such programs available to highlight. 

Many religious-based programs distribute 
informational brochures and materials or engage 
teens in discussion about a range of risky teen 
behaviors including substance abuse, but no 
research is available on their effectiveness in 
preventing substance abuse. For example, some 
Christian organizations such as Teen Challenge 
and some Catholic dioceses distribute materials 
addressing youth substance abuse,^ but these 
materials are not part of larger prevention 
programs that have been evaluated. 



ERIC 



-23- 



31 



Community- and school-based prevention 
programs and the clergy offer opportunities, 
however, to employ the potential power of 
spiritual or religious practice in preventing 
substance abuse and addiction. 

CASASTART 

One rigorously evaluated prevention initiative 
that has been associated with better outcomes 
including lowered substance use, fewer drug 
related or violent crimes and better school 
performance is the parent program of 
CASASTART (Striving to Reach a Rewarding 
Tomorrow). This substance abuse prevention 
program targets children in high risk 
neighborhoods bringing together under one roof 
various organizations including schools, health 
and social service agencies and police, and 
providing participants with mentors and social 
supports for the common purpose of helping 
keep at-risk youth drug and violence free. The 
model encourages youth to participate in 
positive social activities. The most frequently 
reported organized social activities were 
participation in religiously affiliated programs. 
However, the effects of religion or spiritual 
practice have not been isolated.^ 

School-Based Prevention Programs 

Formal substance abuse prevention programs for 
youth are usually delivered by schools. These 
programs may include information about 
substance use and its deleterious effects, provide 
resistance skill building and provoke youth to 
examine their own values/ Current public 
school programs do not include messages about 
religion because of the constitutional separation 
of church and state. However, these curricula 
rarely include-any messages about.spirituality 
(as opposed to religion) except in the form of 
discussing secular ethics and values. 

Clergy 

Clergy members may help prevent substance 
abuse by delivering proscriptive messages, by 

* The parent program of CASASTART called 
Children at Risk (CAR). 



establishing and fostering social networks and 
support for substance abusers and their families, 
and by encouraging individuals to develop 
personal relationships with a higher power that 
may minimize the need to use these substance 
and provide help in resisting their use. No 
evaluations have been done on the efficacy of 
these methods in preventing substance abuse. 

Alcoholics Anonymous and 
Narcotics Anonymous 

Twelve-Step programs such as Alcoholics 
Anonymous (AA) or Narcotics Anonymous 
(NA) rely on spiritual concepts and methods to 
support individuals seeking to abstain from 
substance use.^ Members of AA and NA groups 
commit to abstain from substance use and to use 
the methods or particular steps suggested by the 
program. The spiritual basis of a 12-Step 
program is apparent in its tenets which begin 
with an acknowledgement of God or a higher 
power. 

Involvement in one or more AA or NA 
programs can be a significant part of the process 
of getting well for many individuals impacted by 
addiction and research has documented a 
positive effect of AA or NA program 
involvement.^ Some people have used these 
programs alone to aid their recovery from abuse 
and addiction problems. Others use the 
programs in conjunction with treatment or to 
maintain sobriety after treatment. In a 1998 
survey of 6,800 current members of AA (total 
membership is estimated to be about two million 
people) 47 percent responded that they had been 
sober for five years or more.^ 

Research suggests that those who attend AA and 
NA programs in addition to receiving treatment 
are more likely to be successful in recovery.^ 

One review of 107 studies of AA found that 
those who attend AA during and after treatment 
have better outcomes.^ Other research has 
shown that positive impact of AA up to eight 
years later. This study showed that after eight 
years, of 195 participants who used AA in 
conjunction with treatment, 49.4 percent were in 
remission (remission defined as no alcohol 




-24- 




consumption, no dependence symptoms and no 
drinking related problems in the last six 
months).^ ^ 



The Twelve Steps^^ 

1. We admitted we were powerless over alcohol, 
that our lives had become unmanageable. 

2. Came to believe that a Power greater than 
ourselves could restore us to sanity. 

3. Made a decision to turn our will and our lives 
over to the care of God as we understood Him. 

4. Made a searching and fearless moral inventory of 
ourselves. 

5. Admitted to God, to ourselves, and to another 
human being the exact nature of our wrongs. 

6. Were entirely ready to have God remove all these 
defects of character. 

7. Humbly asked Him to remove our shortcomings. 

8. Made a list of all persons we had harmed, and 
became willing to make amends to them all. 

9. Made direct amends to such people wherever 
possible, except when to do so would injure them 
or others. 

10. Continued to take personal inventory and when 
we were wrong promptly admitted it. 

1 1 . Sought through prayer and meditation to improve 
our conscious contact with God as we understood 
Him, praying only for knowledge of His will for 
us and the power to carry that out. 

12. Having had a spiritual awakening as the result of 
these steps, we tried to carry this message to 
alcoholics, and to practice these principles in all 
our affairs. 



One study found that those who attended AA 
or NA meetings on a weekly basis during and 
after outpatient drug treatment had higher 
rates of abstinence compared to other patients 
attending treatment or AA or NA programs 
alone.^^ In a sample of 2,191 patients who 
entered outpatient drug-free treatment centers, 
those endorsing particular religious or spiritual 
beliefs and those acknowledging problems 
with substance abuse were more likely to 
attend AA or NA meetings while in treatment. 
Those who affiliated with AA or NA groups 
were more likely to report total abstinence 
after three months of treatment than those who 
did not affiliate.^"^ 



Have You Had Any Spiritual Change 
Since Entering Recovery? 

At this point in my life, the only thing Fm 
absolutely sure of is that God loves me and 
he wants me to be happy. 

—Fran 

Age 78, Caucasian Female 



More frequent attendance at AA meetings is 
related to better outcomes. In a study of 415 
outpatient clients in treatment and 621 in 
aftercare, client ratings of the helpfulness of AA, 
the importance of encouragement to attend AA, 
spiritual experiences and consciousness of God 
were positively related with AA meeting 
attendance, Consciousness of God was 
positively related to AA attendance and practice 
of prescribed AA behaviors. Those with 
higher AA attendance and compliance with AA 
practice were more likely to remain abstinent 
and to drink less when drinking occurred.*^ 

Regardless of patients’ religious background, 
individuals who are referred to AA or NA 
programs are more likely to attend meetings and 
persons who attend AA or NA meetings have 
better outcomes. Previous religiousness or 
spirituality is not a prerequisite to gaining the 
benefit of spirituality in recovery including a 12- 
Step process.^® In one study showing lower drug 
use for those who attend NA meetings, previous 
spiritual beliefs were not prerequisites.^^ 

AA and NA programs are entirely self- 
supporting. There are no dues or membership 
fees. Costs related to rental of meeting space 
and refreshments are covered by donations made 
by members at meetings. AA and NA do not 
accept outside contributions.^^ There are no 
public costs to providing the program, making it 
cost beneficial or cost neutral at least. 



er|c 



-25-33 



Intervention 

A range of formal and informal religious- or 
spiritually-based methods are employed to 
interrupt the development of a substance abuse 
problem or to assist an individual to get 
treatment. 

Teen Challenge 

Based on conservative Christian religious 
values. Teen Challenge is a substance abuse 
intervention that engages teens and adults in 
study, dialogue and reflection on Christian 
values. Teen Challenge is affiliated with adult 
residential programs staffed by individuals in 
recovery.^^ Their curriculum is largely one of 
Bible study and uses religious conversion rather 
than medical and behavioral science to combat 
addiction.^'' “Dependence on commitment to 
Jesus Christ as the solution to all problems 
occupies such a central position that relatively 
little attention is given to medical or 
psychological problems, and no records are kept 
concerning these issues. 

While Teen Challenge claims a 70 to 86 percent 
“cure” rate for graduates, they do not take into 
account the high percentages of dropouts. For 
example, one study of selected individuals seven 
years after they entered the program found that 
65 percent of those who came to the program 
dropped out.^^ Another study of the Teen 
Challenge program’s effectiveness in reducing 
substance abuse found that 67 percent or more 
of alumni were living a drug-free lifestyle, but 
the follow-up rate for the study group was only 
50 percent.^’ No rigorous independent 
evaluation has been conducted. 

Other Formal Interventions ' 

AA or NA program members sometimes 
perform formal interventions where they, 
together with family and fiiends, confront 
individuals with substance abuse problems to try 
and get them into treatment. These formal 
interventions may contain spiritual components 
to help the user make the transition to treatment. 



No evaluations have been conducted of the role 
of religion or spirituality in these interventions. 

Informal Interventions 

Less formal interventions such as talking with 
individuals about their substance abuse 
problems, encouraging them to get help, 
referring them to treatment or recovery 
programs, and employing religious or spiritual 
components for support may be conducted by 
clergy, teachers, physicians or other health care 
providers, but once again no data exist 
documenting effectiveness. In some cases, 
referrals to spiritually-based AA or NA 
programs may be used as interventions. A 
spiritually-based referral may be a way of 
engaging individuals who are reluctant to 
engage in treatment or who may not be receptive 
to religious messages. 

Treatment and Recovery 

Seventy-nine percent of Americans believe that 
spiritual faith can help people recover from 
disease and 63 percent think that physicians 
should talk to patients about their spiritual 
faith.^® One survey revealed that more than 75 
percent of patients believed that their doctors 
should address spiritual issues as part of their 
medical care.^® Nearly 40 percent wanted 
doctors to discuss their (i.e., the doctor’s) 
religious faith with them and half expressed a 
desire that their doctors pray with them.^° In an 
early 1990s study of unconventional therapies, 

25 percent of survey respondents* reported using 
prayer as a medical remedy.^’ Another study 
found that 48 percent of hospital inpatients 
wanted their physician to pray with them. Of 
physicians surveyed in 1 996 at a meeting of the 
.i\merican Academy of Family Physicians,-99 
percent were convinced that religious beliefs can 
heal and 75 percent believed that prayers of 
others could promote a patient’s recovery.^^ A 
recent study has also shown that prayer by 
others for a patient has been associated with 
positive outcomes for medical treatment.^^ 



* A national sample of adults age 18 and over. 




34 



- 26 - 



Substance abuse treatment is designed to help an 
individual abstain from alcohol or drug use and 
maintain a substance-free lifestyle and function 
in the family, at work and in society 
Treatment may consist of individual or group 
therapy and be grounded in different theories of 
psychological treatment (i.e., behavior 
modification, psychotherapy, pharmacological 
interventions and combinations of clinical 
options) Religiousness and spirituality can be 
a companion or component of any substance 
abuse treatment modality. 



How Has Your Recovery Impacted Your 
Belief in God? 

Being in recovery has changed the way I see God, 
I came into recovery with a God, but it was a 
punishing, vengeful and unforgiving God. I had 
done so many things ... I knew were ungodly, that 

I thought for sure I was going to Hell When I 

came into recovery I found a new God. I found a 
god that was loving, forgiving understanding and 
responsive to the need that I have. In retrospect, 

I can see that God has been with me all the time?^ 

-Craig 

Age 44, African American Male 



Religion 

For many alcoholics, religion is an important 
part of the recovery process and religious 
orientation, beliefs and practices can change in 
sobriety In one study, AA participants 
considered themselves more religious and 
showed significant changes in spiritual and 
religious practice as their recovery progressed.^^ 

While recovery research has focused more on 
spirituality rather than religiousness, some data 
show that religiousness may contribute to 
treatment success. At one year follow-up for 
101 patients treated in an inpatient alcohol 
rehabilitation unit, using a combined AA or NA 
facilitation/relapse prevention and treatment 
model, self-reported absence of a mainstream 
Christian religious preference strongly predicted 
poor outcome.^^ 



Inmates who engage in religious activities 
appear to have lower rates of recidivism which 
is frequently linked to substance abuse 
Similarly, while many youth in corrective 
settings are there as a result of substance abuse- 
related issues, those who attend religious 
services, participate in religious activities, and 
believe their religion and religious activities are 
important seem to have lower rates of 
delinquency."^^ 

Spirituality 

Spiritual practice— individual belief in and 
connection to a power greater than oneself that 
is not necessarily limited to a particular religion- 
-has been shown to be beneficial in the recovery 
process."^^ Many recovering individuals 
acknowledge the role of spirituality in their 
ability to engage in and maintain recovery."^^ 
Sober alcoholics have reported that their 
recovery was directly related to their spiritual 
beliefs and practices and the social support of a 
community of believers."^"^ While positive past 
experience with religion is not a prerequisite to 
benefiting from spiritual components of 
treatment, it may help. At least one study has 
shown that, the more affirming and positive 
one's childhood religion, the stronger one's 
spirituality in recovery."*^ 

Other research has shown increases in 
spirituality co-occurring with recovery. For 
example, in a study of 62 addicts and a control 
group, recovering individuals showed significant 
increases in elements of spirituality."^^ In a study 
of recovered (sober more than two years) and 
relapsing adults, those in recovery for two years 
had greater levels of faith and spirituality than 
those continuing to relapse; relapsing individuals 
showed significantly lower spirituality levels 
than the general population."^^ 

When patients believe that divine intervention 
will prevail in their choices over the physical 
realities, that their behavior is predetermined and 
they have limited control over their destiny, or 
that God has abandoned them or that they are 
being punished, they may be more likely to 
relapse."^® 



Combining Treatment and Spirituality 

Several treatment programs actively incorporate 
spiritual practice into treatment. Examples are: 

Therapeutic Communities* Therapeutic 
communities (TCs) are residential substance 
abuse treatment programs that rely on mutual 
self-help to facilitate abstinence and recovery 
under the guidance of clinical staff TCs also 
may offer a range of services including group 
and individual therapy, social services 
assistance, employment services and spiritual 
activities particularly AA or NA programs."^^ In 
one study of more than 700 participants in 
treatment, the reduction in heavy alcohol use 
among TC participants was three times greater 
than those who participated in other residential 
treatment and the reduction in marijuana use was 
twice that of those in other residential 
treatment.^^ 

Prison-Based Programs. An example of 
utilizing religious faith as a companion to 
treatment is the role of faith-based instructional 
and support systems within the prison system. 
Founded by Chuck Colson more than 25 years 
ago, the Christian Prison Fellowship Program is 
a Christian outreach program for prisoners, 
exprisoners and their families. The Fellowship 
provides pre-and post-release programs and 
weekly Bible studies focusing on varying topics 
including beginning and continuing one's 
relationship with God, building better families 
and overcoming obstacles such as substance 
abuse.^^ An independent evaluation of this 
program at one-year follow-up showed lower 
recidivism rates for inmates who attended 
religious services on a regular basis. 

The Florida Department of Corrections is 
currently piloting faith-based dormitory 
placement for those seeking substance abuse 
recovery through an enhanced spiritual life.^^ 

Hazelden. Another example of integration of 
spiritual concepts into treatment is the Hazelden 
treatment program originally developed in 
Minnesota. This model offers a continuum of 
treatment components including group and 
individual therapy in a residential or outpatient 



Religion in Alternative Court Programs 

It has been our experience in the Family Drug 
Court that a large percentage of clients have a 
strong spiritual component to their recovery. 
In view of the typical profile of our clients, 
which include long histories of substance 
addition, sexual victimization, physical abuse, 
and a lack of support resources, it is 
important that the Drug Court support their 
recovery in an appropriate manner. 

—Circuit Judge John Pamham 
Family-Focused Parent Drug Court 
Pensacola, FL 



setting. The program extends the concepts of 
the 12-Step support model into a full treatment 
regimen. Results from this program model have 
shown comparable or better outcomes than 
treatment methods based on behavior 
modification and cognitive therapy.^^ One study 
of more than 1,000 people enrolled in the 
Hazelden program showed that after one year 

52.8 percent had not used alcohol or drugs and 

34.8 percent had reduced use. There was no 
control group available for comparison.^^ In a 
separate federal study comparing different 
modes of treatment, however, on average 19 
percent of clients maintained abstinence and 35 
percent avoided heavy use; clients who 
participated in 12-Step supported programs fared 
slightly better than the other modes of 
treatment.^^ 

The Betty Ford Center (BFC). Another 
alcohol and drug dependency treatment center 
that incorporates spiritual practice into its 
treatment program is the BFC in California. 

This Center offers gender specific treatment. An 
extensive medieval and psychosncial assessment 
by a treatment team including a pastoral 
counselor informs an individualized treatment 
plan including lectures on addiction, group 
therapy and individual sessions with counselors. 
Patients also attend AA and NA meetings. A 
key aspect of the treatment program is spiritual 
care— connecting patients with themselves, other 
individuals and a higher power. Special weekly 
groups and individual sessions address Steps 2 
and 3 and include Step 1 1 of the AA/NA 




- 28 - 



36 



programs as vital aspects of ongoing recovery. 
The Center reports that more than two-thirds of 
patients who have completed inpatient care at 
the BFC have not used alcohol or other drugs 
during the year following completion of 
treatment.^® No independent outcome studies 
have been conducted and no data are available 
on program dropout rates. 



The Betty Ford Center accepted our first 
patients on October 4, 1982. Part of the initial 
staff greeting them was a Pastoral Care 
Counselor. Today, this department is called 
Spiritual Care.^^ 

-John T. Schwarzlose 
President, The Betty Ford Center 



Barriers to Linking Treatment and 
Spirituality 

Incorporating spirituality or religiousness as 
components of substance abuse treatment may 
be difficult because of the combination of lower 
religiousness among mental health professionals, 
personal beliefs about religion and spirituality, 
and the lack of training they receive regarding 
these issues. Most psychiatrists rate the training 
they received on religion and spirituality as 
inadequate.®^ 

The general population and family physicians 
believe that spirituality or religiousness is 
important to health and recovery, but mental 
health professionals diverge dramatically from 
these beliefs.®® Psychiatrists and psychologists 
have dramatically lower rates of belief in God in 
contrast to the general population: 73 percent of 
psychiatrists and 72 percent of psychologists 
believe in God in contrast to 96 percent of the 
general public.®' Psychiatrists and psychologists 
consistently report lower levels of importance of 
religion than the general public: nine out of 10 
Americans consider religion to be very 
important or fairly important compared to 56.7 
percent of psychiatrists and 48 percent of 
psychologists.®^ 



report a belief in God. Another study found that 
when mental health specializations are taken 
into consideration, 25 to 40 percent of each 
group report having abandoned the faith of their 
youth, opting for atheism or agnosticism.®^ In 
another study of mental health nurses, while 
both nurse and patients had similar levels of 
reported spirituality, nurses underestimated the 
importance of spirituality to mental health 
patients.®® Medical students also report that they 
are less religious and spiritual than their patients 
and less inclined to consider that spirituality an 
important aspect of patient care.®® 



What Connections Do You See 
Between Your Life, Your Recovery 
and Your Spirituality? 

Recovery is very important to me. My 
spirituality and God are important to me.... 
Tm dealing better. 

—Anonymous 



In a random sample of 355 members of the 
American Psychiatric Association in 1997 to 
1998, 74 percent of psychiatrists disapproved of 
praying with a patient. In this same study, 
physicians were asked “If it were scientifically 
demonstrated that the use of a spiritual 
intervention (e.g., prayer) improved patient 
progress, would you perform that intervention?” 
Only 37 percent of psychiatrists responded 
affirmatively.®’ Just over half (57 percent) of 
psychiatrists would recommend that the patient 
consult with a member of the clergy; six percent 
would do neither. 



A survey conducted by Gallup found that only 
40 to 45 percent of mental health practitioners 




35 ’ 




Chapter VI 

Making the Spiritual Connection 



Each religious and spiritual tradition has it own 
unique resources to bring to bear to minimize 
substance abuse and to aid recovery. To take 
advantage of the potentially positive benefits of 
religion and spirituality to prevent substance 
abuse, intervene in its progress and help 
individuals recover from its effects, CASA 
recommends: 



For the Clergy 

• Protestant, Catholic, Rabbinical and other 
schools of theology and seminaries should 
train clergy to recognize the signs and 
symptoms of substance abuse and know how 
to respond, including referral to treatment 
and strategies for relapse prevention. These 
schools should provide basic educational 
and clinical knowledge of the short and long 
term effects of tobacco, alcohol and other 
drugs and educate their students about ways 
to incorporate prevention messages both 
formally and informally into their work. 
They should educate their students about the 
co-occurrence of mental health and other 
problems (such as domestic violence and 
child abuse) and substance abuse. These 
schools should include courses related to 
substance abuse in degree requirements and 
provide in-service training for current 
clergy. 

• Clergy members who have completed their 
formal training should take advantage of 
additional substance abuse training in order 
to be knowledgeable about the topic. 
Resources include: local public substance 
abuse treatment agencies, private licensed 
substance abuse professionals, substance 
abuse professional organizations such as the 
National Association of State Alcohol and 
Drug Agency Directors (NASADAD), 
federal resources such as the National 
Institute on Drug Abuse and the National 





Institute on Alcohol Abuse and Alcoholism, 
the U.S. Department of Health and Human 
Services Substance Abuse and Mental 
Health Services Administration and its 
Centers for Substance Abuse Prevention and 
Substance Abuse Treatment. 

Members of the clergy should preach about 
substance abuse issues and informally 
include messages about the problem 
throughout their organization’s programs, 
services and counseling. Even religions 
with assigned readings and themes for 
sermons can incorporate messages about 
substance abuse as examples and prayers for 
those addicted in their services. 

Recognizing that substance abuse affects 
individuals and families in all congregations, 
clergy can inform their members with 
prevention messages, and help connect 
members of their community to needed 
intervention and treatment resources and, as 
many presently do, open their facilities to 
AA and NA meetings. 

Members of the clergy should reach out to 
treatment programs to offer spiritual support 
to individuals who desire such assistance. 
Clergy can help educate treatment providers 
of the promising effects of spirituality and 
religion in recovery. Clergy should learn 
about treatment programs in their 
communities. By building this relationship, 
clergy will know who to refer members to 
for treatment and know how to support 
referrals from treatment providers of clients 
seeking to deepen their spiritual life. 

Participants in recovery may have great 
needs for spiritual guidance. Individuals 
struggling to recover may feel abandoned by 
God or alienated from God or the religious 
community. Clergy can help recovering 
individuals navigate these issues and benefit 
from a connection to a loving God and 
religious community. 



For Physicians and Treatment 
Providers 

For many individuals, spirituality and 
religiousness can be important companions to 
recovery and maintaining sobriety. 

• Physician and other health professions 
training programs should educate physicians 
and treatment specialists to understand that 
many patients desire spiritual help as 
complements to medical treatment, and the 
research documenting the benefits of 
spirituality and religiousness to physical and 
mental health. 

• Physicians and substance abuse treatment 
specialists should discuss patients’ spiritual 
needs and desires and, where appropriate, 
refer clients to clergy or spiritually-based 
programs to support their recovery. 

• Substance abuse treatment providers 
(physicians and other health clinicians) 
should establish working relationships with 
local clergy members not only to educate 
clergy members about substance abuse but 
also to better respond to patients needs and 
desires for a spiritual complement to their 
recovery regimen. 

Expand Our Current Knowledge 
Base 

• More research is needed to evaluate the 
efficacy and increase the effectiveness of 
faith-based prevention initiatives and 
treatment programs, develop better ways of 
measuring adolescent spirituality and 
religiousness and document pathways 
through which religion and spirituality work 
to prevent substance abuse and aid in 
recovery. 



Chapter I 
Notes 

' The National Center on Addiction and Substance Abuse (CASA) at Columbia University. (2001). The National 
Center on Addiction and Substance Abuse (CASA) at Columbia University. (1999). 

^ The National Center on Addiction and Substance Abuse (CASA) at Columbia University. (1998b). 

^ The National Center on Addiction and Substance Abuse (CASA) at Columbia University. (1998a). 

“ Harrell, A. V., Cavanagh. S., & Sirdharan, S. (1998). 





Chapter II 
Notes 



^ Miller, W. (1998). 

^ National Institute on Alcohol Abuse and Alcoholism, & Fetzer Institute. (1999). 

^ Newport, F. (1999). 

^ Amey, C. H., Albrecht, S. L., & Miller, M. K. (1996); Hawks, R. D., & Bahr, S. H. (1992). 

^ Larson, D. B., Swyers, L A., & McCullough, M. E. (1998); Center to Improve Care of the Dying (2001). 

^Gallup, G.H. (2001). 

’ U.S. Census Bureau. (2001b). 

^ American Muslim Council. (2000); U. S. Department of State, International Information Program. (2001). 

^ Gallup, G. H. (2001); Gallup, G. H. (1996). 

National Opinion Research Center (1990-2000). See Appendix A 
National Opinion Research Center (1990-2000). See Appendix A 
Mathew, R. J., Mathew, V. G., Wilson, W. H., & Georgi, J. M. (1995). 

The National Center on Addiction and Substance Abuse (CASA) at Columbia University analysis of 1998 
National Household Survey on Drug Abuse data. (2001). 

Larson, D. B., Swyers, J. A., & McCullough, M. E. (1998); Adlaf, E. M., & Smart, R. G. (1985). 

The National Center on Addiction and Substance Abuse (CASA) at Columbia University analysis of 1998 
National Household Survey on Drug Abuse data. (2001); U. S. Census Bureau. (2001a). 

The National Center on Addiction and Substance Abuse (CASA) at Columbia University analysis of 1998 
National Household Survey on Drug Abuse data. (2001); U. S. Census Bureau. (2001a). 

The National Center on Addiction and Substance Abuse (CASA) at Columbia University analysis of 1998 
National Household Survey on Drug Abuse data. (2001); U. S. Census Bureau. (2001a). 

The National Center on Addiction and Substance Abuse (CASA) at Columbia University analysis of 1998 
National Household Survey on Drug Abuse data. (2001); U. S. Census Bureau. (2001a). 

Yamold, B. M. (1999b); Yamold, B. M., & Patterson, V. (1998). 

Yamold, B. M. (1999a). 

Grunbaum, J. A., Tortolero, S., Weller, N., & Gingiss, P. (2000). 

Benda, B. B., & Corwyn, R. F. (2000). 

Bahr, S. J., Maughan, S. L., Marcos, A. C. & Li, B. (1998). 

Hadaway, C., Elifson, K., & Petersen, D. (1984), Coombs, R., Wellisch, D., & Fawzy, F. (1985). 

Miller, L., Davies, M., & Greenwald, S. (2000). 

The National Center on Addiction and Substance Abuse (CASA) at Columbia University analysis of 1998 
National Household Survey on Dmg Abuse data. (2001). 

The National Center on Addiction and Substance Abuse (CASA) at Columbia University analysis of 1999 CASA 
Teen Survey data. (2001). 

Forthun, L. F., Bell, N. J., Peek, C. W., 8c Sun, S. W. (1999). 

Engs, R. C., Diebold, B. A., & Hanson, D. J. (1996). 

Patock-Peckham, J. A., Hutchinson, G. T., Cheong, J., & Nagoshi, C. T. (1998). 

Patock-Peckham, J. A., Hutchinson, G. T., Cheong, J., & Nagoshi, C. T. (1998). 

McBride, D., Mutch, P., & Chitwood, D. (1996). 

Bell, R., Weschsler, H., & Johnston, L. (1997). 

McCullough, M. E, Hoyt, W. T., Larson, D. B., Koenigh, H. G., & Thoresen, C. (2000). 

Larson, D. B., Larson, S. S., & Koenig, H. G. (2001); Koenig, H. G., & Larson, D. B. (1998). 

Koenig, H. G., & Larson, D. B. (1998); Koenig, H. G., Cohen, H. J., George, L. K., Hays, J. C., Larson, D. B., & 
Blazer,D. G. (1997). 

Wenneberg, S. R., Schneider, R. H., Walton, K. G., Maclean, C. R., Levitsky, D. K., Salerno, J. W., Wallace, R. 
K., Mandarino, J. V., Rainforth, M. V., & Waziri, R. (1997). 

Kabat-Zinn, J., Lipworth, J., & Burney, R. (1985). 

Cooper, M. J., & Aygen, M. M. (1979). 

Kaczorowski, J. (1989). 

Hawks, S. R., Hull, M. L., Thalman, R. L, & Richins, P. M. (1995). 

Gorsuch, R. (1995). 



O 

ERIC 



- 34 - 



41 



Chapter m 
Notes 



^ McBride, D., Mutch, P., & Chitwood, D. (1996). 

2 Miller, W. R. (1998). 

^ Enyclopedia Brittanica online. (2001). 

"^Owen, R. (1999); Veenker, J. (1999). 

^ Gorsuch, R. L. (1995); Cherrington, 1920, as cited by McBride, D., Mutch, P., & Chitwood, D. (1996). 

^ McBride, D., Mutch, P., & Chitwood, D. (1996). 

^ McBride, D., Mutch, P., & Chitwood, D. (1996). 

^ Gorsuch, R. L. (1995). 

^ McBride, D., Mutch, P., & Chitwood, D. (1996). 

Kinsley, D. R. (1993), pp. 5-7. 

Muller, F. M., 8c Biihler, G. (Eds.) (1975), p. 105. 

Thiruvalluvar (Sundaram, P. S., translator). (1987), p. 97. 

Lopez,D.S. (2001),p. 37. 

‘^Stryk, L. (1968),p. 236. 

Personal communication, Father Frank Clooney, Boston College, Department of Theology, October 26, 2001 . 
McBride,D., Mutch, P., & Chitwood, D. (1996). 

Bahr, S. J., & Hawks, R. D. (1995). 

Park, H. S., Ashton, L., Causey, T., & Moon, S. S. (1998). 

Park, H. S., Ashton, L., Causey, T., & Moon, S. S. (1998). 

Graves, A. B. (2000, May 22). 

Morgan, O. J., & Jordan, M. (1999). 

Bahr, S. J., & Hawks, R. D. (1995). 

Bahr, S. J., & Hawks, R. D. (1995^ 

Olitzky, K. M., & Copans, S. A. (1991). 

Gorsuch, R. L. (1995). 

Coombs, R., Wellisch, D., & Fawzy, F. (1985). 

Hadaway, C., Elifson, K., & Petersen, D. (1984). 

Richter L., & Richter D. M. (2001); Weinberg N. Z., Dielman, T. E., Mandell, W., & Shope, J. T. (1994); 
Andrews, J. A., Hops, H., Ary, D., Tildesley, E., & Harris, J. (1993); Chassin, L., Pillow, D. R., Curran, P. J., 
Molina, B., & Barrera, M. (1993); Pandina, R. J. & Johnson, V. (1989). 

The National Center on Addiction and Substance Abuse (CASA) at Columbia University. (1999). 

Bahr, S. J., Maughan, S. L., Marcos, A. C., & Li, B. (1998). 

The National Center on Addiction and Substance Abuse (CASA) at Columbia University. (2001). 

The National Center on Addiction and Substance Abuse (CASA) at Columbia University. (1999). 

Sieving, R., Perry, C. L., & Williams, C. L. (1999). Bahr, S. J., Maughan, S. L., Marcos, A. C., & Li, B. (1998). 
The National Center on Addiction and Substance Abuse at Columbia University. (2001). 

Bahr, S. J., Maughan, S. L., Marcos, A. C., (& Li, B. (1998). 

Benda, B. B., & Corwyn, R. F. (2000); McBride,D., Mutch, P., & Chitwood, D. (1996). 

Benda, B. B., & Corwyn, R. F. (2000); The National Center on Addiction and Substance Abuse (CASA) at 
Columbia University. (2001). 

Benda, B. B., & Corwyn, R. F. (2000). 

Nelson-Zlupko, L., Kauffman, E., & Dore, M. M. (1995); Rachlin, 2000, as cited in Bickel, W. K., & Vuchinich, 
R. E. (2001), pp. 145-164; Shinn, M., Weitzman, B. C., Stojanovic, D., Knickman, J. R., Jimenez, L., Duchon, L., 
James, S., & Krantz, D. H. (1998); Word, C. O., & Bowser, B. (1997); Adlaf, E. M., & Smart, R. G. (1985). 
LaPierre, L. L. (1994). 

"^^Sloan, R. P., Bagiella, E., & Powell, T. (1999). 

Dezell, M. (2000). 

Florentine, R., & Hillhouse, M. P. (2000). 

Nealon-Woods, M. A., Ferrari, J. R., & Jason, L. A. (1995). 

Rush, M.M. (1997). 

Churchill, M. (1998); Galanter, M. (1990). 



Shinn, M., Weitzman, B. C., Stojanovic, D., Knickman, J. R., Jimenez, L., Duchon, L., James, S., & Krantz, D. H. 
(1998); Word, C. O., & Bowser, B. (1997). 

The National Center on Addiction and Substance Abuse (CASA) at Columbia University. (1998). 

Jamsiewicz, B. (1999). 

Sloan, H. P. (1999). 

Carroll, J., McGinley, J. J. & Mack,S. E. (2000). 

Sloan, H. P. (1999). 

” Mathew, R. J., Mathew, V. G., Wilson, W. H., & Georgi, J. M. (1995). 



43 




- 36 - 



Chapter IV 
Notes 

' Personal communication, Father Raymond B. Kemp, Senior Fellow, Woodstock Theological Center, October 25, 

2001 . 

^ Personal communication. Father Raymond B. Kemp, Senior Fellow, Woodstock Theological Center, November 7, 
2001 . 





- 37 - 



Chapter V 
Notes 



' Sloan, R. P., Bagiella, E., Powell, T. (1999). 

^ Bahr, S. J., & Hawks, R.D. (1995). 

^ Harrell, A. V., Cavanagh, S., & Sirdharan, S. (1998). 

■* Botvin, G. J. (1996). 

’ Alcoholics Anonymous. (2001c); Narcotics Anonymous World Services. (1985b). 

® Emrick, C. D. (1999); Winzelberg, A., & Humphries, K. (1999); Chappel, J. N., (1997); Emrick, C. D., Tonigan, 
S., Montgomery, H., & Little, L. (1993). 

’ Alcoholics Anonymous. (2001a). 

® Winzelberg, A., & Humphreys, K. (1999); Emrick, C. D., Tonigan, S., Montgomery, H., & Littlej L. (1993). 

® Emrick, C. D., Tonigan, S., Montgomery, H., & Little, L. (1993). 

Humphreys, K., Moos, R. H., & Cohen, C. (1997). 

" Humphreys, K., Moos, R. H., & Cohen, C. (1997). 

Alcoholics Anonymous. (2001c). 

Florentine, R., & Hillhouse, M. P. (2000a), (2000b). 

'■* Giffen, D. L. (1995). 

” Humphreys, K., Moos, R. H., & Cohen, C. (1997). 

Tonigan, J. S., Miller, W. R., & Connors, G. J. (2000). 

’’ Tonigan, J. S., Miller, W. R., & Connors, G. J. (2000). 

Tonigan, J. S., Miller, W. R., & Connors, G. J. (2000). 

Winzelberg, A., & Humphreys, K. (1999). 

Jones, G. S. (1995). 

Christo, G., & Franey, C. (1995) 

Alcoholics Anonymous. (2001b); Narcotics Anonymous World Services, (2001a). 

Muffler, J., Langrod, J., & Larson, D. (1992). 

Muffler, J., Langrod, J., & Larson, D. (1992). 

Muffler, J., Langrod, J., & Larson, D. (1992). 

^ Hess’s study (as cited in Muffler, J., Langrod, J., & Larson D., 1 992). 

Teen Challenge. (1994). 

Sloan, R. P., Bagiella, E., & Powell, T. (1999). 

Matthews, D., McCullough, M., Larson, D., Koenig, H, Swyers, J., & Milano, M. (1998). 

Matthews, D., McCullough, M., Larson, D., Koenig, H., Swyers, J., & Milano, M. (1998). 

Eisenberg, D., Kessler, R., Foster, C., Norlock, F., Calkins, D., & Delbanco, T. (1993) 

Sloan, R. P., Bagiella, E., & Powell, T. (1999). 

” Nagoumey, E. (2001, October 15). 

National Institute on Dmg Abuse. (1999). 

National Institute on Dmg Abuse. (1999). 

Sloan, H.P. (1999). 

” Coons, S. (1996). 

Coons, S. (1996X 

Craig, T. J., Krishna, G., & Poniarski, R. (1997). 

The National Center on Addiction and Substance Abuse (CASA) at Columbia University. (1998a). 

■* The National Center on Addiction and Substance Abuse (CASA) at Columbia University, (forthcoming); Johnson, 
B. R., Jang, S. J., Larson, D. B., & De Li, S. (2001). 

'*^Jamsiewicz, B. P. (1999). 

Galanter, M. (1999); Jamsiewicz, B. P. (1999). 

Rush, M.M. (1997). 

Sloan, H.P. (1999). 

Mathew, R. J., Georgi, J., Wilson, W. H., & Mathew, V. G. (1996). 

Jamsiewicz, B. P. (1999). 

Sloan,H. P. (1999). 

Phoenix House. (2001); De Leon, G. (1999). 

National Institute on Dmg Abuse. ( 1 994). yj ^ 




- 38 - 



Prison Fellowship Ministries. (2001a,), (2001b), (2001c), (200 Id). 

Johnson, B. R., Larson, D. B., & Pitts, T. C. (1997). 

Join Together Online. (2001). 

Personal communication, John Pamham, Circuit Judge, Family-Focused Parent Drug Court, November 2, 2001 . 
Stinchfield, R., & Owen, P. (1998). 

Stinchfiled, R., & Owen, P. (1998). 

Project MATCH Research Group’s study (as cited in Stinchfield, R., & Owen, P., 1998). 

Betty Ford Center at Eisenhower. (2001). 

^^Shaffanske, E. (2000); Chappel, J. N. (1997). 

^®Sloan,R. P.; Bagiella, E.; Powell, T. (1999); Shafranske, E. (2000). 

Shafranske, E. (2000). 

Shafranske, E. (2000). 

John T. Schwarzlose, President, The Betty Ford Center, (personal communication, October 23, 2001). 

Muffler, J., Langrod, J. G., & Larson, D. (1992). 

^^McDowell, D., Galanter, M., Goldfarb, L., & Lifshutz, H. (1996). 

Goldfarb, L. M., Galanter, M., McDowell, D., Lifshutz, H., & Dermatis, H. (1996). 

Shafranske, E. (2000). 



46 

ERIC 



- 39 - 



Appendix A 

National Data Sets 



CASA used the following national data sets in 
this analysis: 

National Household Survey on 
Drug Abuse 

The National Household Survey on Drug Abuse 
(NHSDA) is designed to produce drug and 
alcohol use incidence and prevalence estimates 
and report the consequences and patterns of use 
and abuse in the general U.S. civilian population 
aged 12 and older. The survey collects data by 
administering questionnaires to a representative 
sample of the population through face-to-face 
interviews at their place of residence. The 
survey is sponsored by the Substance Abuse and 
Mental Health Services Administration 
(SAMHSA). and data collection is carried out by 
Research Triangle Institute. CASA utilized the 
1998 NHSDA database for these analyses. 

CASA’s Auuual Natioual Survey of 
Americau Attitudes ou Substauce 
Abuse 

Since 1995, CASA has conducted national 
surveys of teens’ attitudes toward substance 
abuse as well as the attitudes of those who most 
influence them-parents, teachers and school 
principals. Other surveys seek to measure the 
extent of substance use in the population; 
CASA’s survey probes substance abuse risk. 

The purpose of the survey is to identify factors 
that increase or diminish the likelihood that 
teens will use cigarettes, alcohol or illegal drugs 
in an effort to develop the most effective means 
of helping teens avoid substance abuse. CASA 
used the 1999 and 2001 surveys for this report. 



47 

-40- 

o 

ERIC 



General Social Survey 



Few national data sets collect data regarding 
religious affiliation. The GSS (General Social 
Survey) is an annual "omnibus," personal 
interview survey of U.S. households conducted 
by the National Opinion Research Center 
(NORC) since 1972. The database consists of 
over 38,000 respondents. For the purposes of 
this research, this data reflect the average 
percentage of respondents from 1990-2000. 
CASA chose respondents from this time frame 
to most closely mirror the sources used by the 
latest U.S. Census Bureau estimates cited earlier 
in Chapter II. 



Appendix B 

CASA’s Surveys of Clergy and Schools of Theology 

CLERGY PREPARATION SURVEY 

Please enter requested information in the blank or check off your answers to the following questions. 

Your participation is greatly appreciated. 

1 D enomi nati on : 

2. When you were preparing for ordained ministry were you required to take a course(s) dedicated 
specifically to providing information about the nature and consequences of alcohol or drug abuse and 
addiction? 

Yes Number of credits are required No 

3. Since ordination, have you sought training on your own to assist parishioners seeking help with 
alcohol or drug abuse and addiction? 

Yes No 



4. Among the problems clergy confront in their congregations, how important do you consider alcohol 
and other drug use/abuse? Please check only one. 

Very Important 

Somewhat Important 

Not Important 

Don’t Know 



5. What proportion of family problems you confront (divorce, separation, spouse abuse, child neglect or 
abuse) involves alcohol abuse? 

75% or more 

50% or more 

Less than 50% 

Less than 25% 



6. How often do you preach a sermon addressing substance abuse at your principal weekly worship 
service? 

Never 

More Than Once a Year 

Annually 

Every Couple of Years 



Please fax your completed survey to Dr. John Muffler at (212) 956-8020. 
If you prefer, please feel free to use the enclosed, self-addressed envelope. 



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49 



SCHOOLS OF THEOLOGY SURVEY 



Name of Institution: 



{For tracking purposes only) 



Please enter requested information in the blank or check off your answers to the following questions. 
Your participation is greatly appreciated. 



1. Denomination: 

2. For persons preparing for ordained ministry, how many credits are required for graduation? 



3. Are persons preparing for ordained ministry required to take a course(s) dedicated specifically to 
providing information or pastoral counseling training about the nature and consequences of alcohol 
and drug abuse and addiction? 

Yes Number of credits are required No 

4. Among the family problems clergy confront in their congregations, how important do you consider 
alcohol and other drug use/abuse? Please check only one. 

Very Important 

Somewhat Important 

Not Important 

Don’t Know 



Please fax your completed survey to Dr. John Muffler at (212) 956-8020. 
If you prefer, please feel free to use the enclosed, self-addressed envelope. 




-43- 



50 



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